Efficacy of stented elephant trunk procedure for right-sided aortic arch with Kommerell's diverticulum
- VernacularTitle:直视支架象鼻手术治疗右位主动脉弓合并Kommerell憩室的疗效分析
- Author:
Yongliang ZHONG
;
Bing TANG
1
;
Suwei CHEN
1
;
Yipeng GE
1
;
Hai'ou HU
1
;
Zhiyu QIAO
1
;
Chengnan LI
1
;
Yongmin LIU
1
;
Junming ZHU
1
Author Information
1. Department of Cardiovascular Surgery and Aortic Surgery Center, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Aortic Disease Center, Beijing, 100029, P. R. China
- Publication Type:Journal Article
- Keywords:
Stented elephant trunk procedure;
right-sided aortic arch;
Kommerell’s diverticulum;
aberrant left subclavian artery;
aortic aneurysm
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2024;31(07):1020-1026
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize our experience and the early and midterm outcomes of stented elephant trunk procedure for right-sided aortic arch (RAA) with Kommerell's diverticulum (KD). Methods From April 2013 to July 2020, patients with RAA and KD who underwent stented elephant trunk procedure at our center were collected. Surgery was performed under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy. Results A total of 8 patients were included, including 7 males and 1 female with a mean age of 51.88±9.61 years. All patients had an aneurysmal KD and aberrant left subclavian artery. Preoperative comorbidities included acute Stanford type B aortic dissection in 1 patient, aortic arch pseudoaneurysm in 1 patient, acute type B intramural hematoma in 2 patients, and coronary artery disease in 1 patient. Concomitant procedures included reconstruction of the left subclavian artery in all patients and coronary artery bypass grafting in 1 patient. The mean time of operation, cardiopulmonary bypass, aortic cross-clamping, and selective cerebral perfusion was 6.25±1.16 h, 157.75±40.07 min, 77.75±33.10 min, and 28.50±5.55 min, respectively. No intraoperative death occurred. There was 1 in-hospital death. Follow-up was completed in all patients with a mean period of 3.58±2.08 years. No late death occurred. A persistent anastomotic leak of the proximal arch was detected in 1 patient, but reintervention was not performed because neither aortic dilatation nor symptoms of tracheal and esophageal compression were observed during the follow-up. The remaining 6 patients showed positive aortic remodeling with complete thrombosis of the aneurysmal KD, and neither aortic event nor tracheal and esophageal compression occurred. Conclusion Stented elephant trunk procedure is a safe and feasible technique for selected patients with RAA and KD, which can achieve favorable early and midterm outcomes.
