Strategy and clinical outcomes of open surgical repair for adult Kommerell's diverticulum: a retrospective cohort study and our 10-year experience.

OBJECTIVES

To report our strategy and outcomes in open surgically treating adult Kommerell's diverticulum (KD) over the past decade.

METHODS

44 patiens who underwent open surgical repair for KD at our institution between 2015 and 2024 were enrolled. Patients were classified as aneurysm group (n = 25, 56.8%) or dissection (n = 19, 43.2%) group. Depending on the position and pathology, 1 of 4 procedures was performed: (1) descending aorta replacement and aberrant subclavian artery reconstruction; (2) total arch and partial descending aorta replacement; (3) thoracoabdominal aortic replacement; or (4) total arch replacement with frozen elephant trunk. Long-term prognosis and perioperative safety were analyzed.

RESULTS

Early mortality and composite adverse events for the overall cohort were 13.6% and 20.5%, respectively, without significant differences between the aneurysm and dissection groups (8.0% vs 21.1%, P = 0.42; 16.0% vs 26.3%, P = 0.32). However, the dissection group had a higher rate of acute kidney injury (52.6% vs 20.0%, P = 0.02), longer mechanical ventilation (33.4 [13.2∼122.1] vs 14.2 [6.8∼22.7] h, P = 0.005), longer intensive care unit stay (5 [3∼10] vs 2 [1∼5] d, P = 0.001), and longer postoperative hospitalization (15 [14∼21] vs 10 [7∼18] d, P = 0.007). For the entire cohort, 5-year overall survival and freedom from aortic-related reintervention were 77.8% and 88.9%. Patients in the dissection group had significantly lower 5-year overall survival (61.2% vs 92.0%, P=0.022) and freedom from aortic-related reintervention rates (77.3% vs 100%, P=0.036).

CONCLUSIONS

Open surgical strategy was selected arrording to the position and pathology of KD. Open surgery achieved acceptable early and long-term outcomes. Once KD progressed to dissection, the difficulty and risk of open surgery increased and the long-term prognosis was impaired.