Surgical repair of type Ⅱ right-sided aortic arch with Kommerell diverticulum
10.3760/cma.j.cn112434-20221230-00397
- VernacularTitle:Ⅱ型右位主动脉弓合并Kommerell憩室的外科治疗
- Author:
Bing TANG
1
;
Yongliang ZHONG
;
Yipeng GE
;
Haiou HU
;
Zhiyu QIAO
;
Chengnan LI
;
Yongmin LIU
;
Junming ZHU
Author Information
1. 首都医科大学附属北京安贞医院心脏外科、主动脉外科中心 北京市心肺血管疾病研究所 北京市大血管疾病诊疗研究中心，北京 100029
- Keywords:
Right-sided aortic arch;
Kommerell’s diverticulum;
Aberrant left subclavian artery;
Aortic aneurysm;
Surgical repair
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(8):454-460
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize our experience and outcomes of surgical repair of type Ⅱ right-sided aortic arch(RAA) with Kommerell's diverticulum(KD).Methods:From May 2010 to August 2020, a total of 13 patients with type Ⅱ RAA and KD underwent surgery at our center. Mean age was(50.46±10.31) years, 10 were male, and 3 were female. All patients had an aneurysmal KD and aberrant left subclavian artery(ALSA). Preoperative comorbidities included type B aortic dissection in 1 case, aortic arch pseudoaneurysm in 2 cases, and type B intramural hematoma in 2 cases, respectively. Eight(61.5%) patients underwent stented elephant trunk procedures under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy, and all of them had ALSA reconstruction. Five(38.5%) patients underwent distal arch and descending thoracic aortic replacement through a right posterolateral thoracotomy, the ALSA was reconstructed or ligated in 1 each, and ALSA embolization was performed before surgery in the other 3 cases.Results:No operation deaths occurred. Recurrent laryngeal nerve injury occurred in 2 cases. There was 1(7.69%) in-hospital death. Follow-up was complete in 100 % at mean(5.28±3.84) years. No late death occurred. A persistent anastomotic leak of the proximal arch was detected in a patient who underwent stented elephant trunk procedure, but no aortic dilatation or tracheal and esophageal compression was observed during follow-up. Meanwhile, aortic events, limb ischemia, or symptoms of tracheal and esophageal compression were not observed in the remaining 11 patients.Conclusion:Surgical repair of type Ⅱ RAA with KD can achieve favorable early and midterm outcomes. Surgical strategies should be chosen based on the anatomy of the aorta and whether it is combined with compression symptoms.
