Outcomes of surgical management for Kommerell's diverticulum associated with type B aortic dissection.

Abstract

Objectives: Kommerell's diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell's diverticulum associated with type B aortic dissection.

Methods: This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell's diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell's diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery.

Results: The median age of the patient was 49 years (interquartile range: 42.2-58.5). There were no in-hospital or 30-day postoperative deaths. All patients were discharged with a median hospital stay of 8.5 days (interquartile range: 7.75-10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (standard deviation: 15.3) months, during which no adverse events occurred.

Conclusions: This surgical approach for managing Kommerell's diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.