Abstract
Objectives The surgical treatment of Kommerell diverticula is associated with high mortality
and morbidity rates. In the mid-2000s, hybrid aortic arch repair was developed, and
the procedure has since been used to repair Kommerell diverticula. In the present
study, we focused on the postoperative outcomes of two-stage hybrid repair of Kommerell
diverticula that required supra-aortic debranching (type I hybrid arch repair).
Methods From August 2010 to July 2013, a total of four patients (aged 73.5 ± 9.5 years) underwent
two-stage hybrid repair (type I hybrid arch repair) for Kommerell diverticula, and
their cases were retrospectively studied. All four patients had right aortic arches
and aberrant left subclavian arteries. The repair procedure consisted of two stages:
(1) debranching of the supra-aortic vessels via a median sternotomy; (2) exclusion
of the Kommerell diverticulum by performing thoracic endovascular repair via a femoral
approach and coil embolization of the orifice of the aberrant subclavian artery.
Results There were no in-hospital deaths. One patient developed an acute kidney injury and
required hemodialysis on postoperative day 2, although his renal function recovered
within 48 hours. No strokes, paraplegia, or early aortic events were observed in our
series. The mean follow-up period was 19.5 months (range, 5–47 months). All patients
remained free from aortic events and endoleaks during the follow-up period.
Conclusion The early and mid-term outcomes of hybrid repair for Kommerell diverticula that require
supra-aortic debranching, which are less invasive and do not involve hypothermic circulatory
arrest, are acceptable. However, this procedure requires the insertion of an endograft
into the ascending aorta, and careful and long-term follow-up is required to confirm
its efficacy.
Keywords
Kommerell diverticulum - thoracic endovascular aortic repair - hybrid arch repair
