Staged Hybrid Repair of Right-Sided Aortic Arch With Kommerell Diverticulum and Aberrant Left Subclavian.

BACKGROUND

Right-sided aortic arch (RAA) with Kommerell diverticulum (KD) and aberrant subclavian artery is a rare congenital anomaly that can present with aneurysmal degeneration requiring complex repair.

CASE SUMMARY: A 22-year-old man with right-sided aortic arch, Kommerell diverticulum, and minimal dilation of the aortic root, arch, and descending thoracic aorta underwent a 3-stage hybrid repair. Stage 1 involved bilateral subclavian artery transpositions, stage 2 included open total arch and root reconstruction with a Thoraflex Hybrid frozen elephant trunk, and stage 3 was completed with thoracic endovascular aortic repair overlapping the previously placed stent. Postoperative recovery was favorable.

DISCUSSION: This case illustrates the effectiveness of a staged hybrid strategy in managing complex congenital aortic anomalies. It emphasizes the value of tailored surgical planning, multidisciplinary care, and modern prosthetic technology in optimizing outcomes.

TAKE-HOME MESSAGES: A staged hybrid strategy is beneficial for treating rare congenital aortic arch anomalies with aneurysmal degeneration in young adults. Successful outcomes rely on individualized surgical planning and multidisciplinary collaboration to minimize risk and maximize durability.