Surgical strategy for Kommerell's diverticulum: total arch replacement.

OBJECTIVE

Kommerell's diverticulum is a rare congenital aortic arch anomaly. Various surgical techniques have been reported; however, the surgical strategy is still controversial. In our institute, total arch replacement (TAR) and anatomic reconstruction of the subclavian artery (SCA) has been selected for the treatment of Kommerell's diverticulum to release the vascular ring completely and prevent postoperative complications, including dissection, rupture, hand ischemia, and subclavian steal syndrome.

METHODS

From 2000 to 2012, 4 patients (aged 38-72 years) underwent TAR and anatomic reconstruction of the SCA for Kommerell's diverticulum. All patients had a right aortic arch with an aberrant left SCA. The indications for surgery were dysphagia and dilatation of Kommerell's diverticulum. TAR, using hypothermic cardiopulmonary bypass and circulatory arrest, was performed through a median sternotomy and right anterolateral thoracotomy. After resection of Kommerell's diverticulum, the SCA was reconstructed with a graft.

RESULTS

No hospital deaths or major complications occurred, but a 72-year-old patient required prolonged hospitalization for respiratory failure. All patients were discharged from the hospital and were free of symptoms, rupture, dissection, hand ischemia, and subclavian steal syndrome at 5 months to 11 years postoperatively.

CONCLUSIONS

TAR is a reasonable surgical technique for Kommerell's diverticulum, because it enables the vascular ring to be completely released, preventing recurrence, rupture, and dissection. Anatomic reconstruction of the SCA was effective to prevent hand ischemia and subclavian steal syndrome.