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Collaborative Staged Surgical Repair Of Kommerell Diverticulum And Aberrant Left Subclavian Artery In Adolescents And Young Adults
Kyle W. Riggs, MD, Soyoung Cheon, MD, Reagan M. Setser, MD, David J. Minion, MD, Carl L. Backer, MD.
University of Kentucky, Lexington, KY, USA.
Objective(s): Staged surgical repair of a Kommerell diverticulum (KD) is a specialized approach used to treat adults and older children with large thoracic cavities that are challenging to safely reimplant the subclavian artery into the carotid artery through a thoracotomy as is standard in small children.
Methods: We present a series of four adolescent patients who underwent staged repair of a right-sided aortic arch with an aberrant left subclavian artery arising from a KD. Stage one consisted of left subclavian-to-carotid artery transfer through a supraclavicular incision. Stage two was performed six weeks later via left thoracotomy with division of the ligamentum arteriosum and excision of the KD.
Results: Average age of the patients was 16.8 years; 50% were males. Average weight at time of surgery was 80.2kg, ranging from 54.9 to 102.0kg. All patients had only dysphagia symptoms pre-operatively and one patient was a redo thoracotomy following a prior KD aortopexy. Patients stayed overnight after the supraclavicular operation and did not require antiplatelet therapy. Length of stay after thoracotomy was 2, 3, 3 and 5 days, with one patient developing a chylothorax which resolved with a low-fat diet. All patients’ symptoms were resolved by discharge and on follow-up.
Conclusions: Staged repair of KDs in adolescents and young adults with large thoracic cavities is a safe and effective alternative to challenging subclavian-to-carotid transfers via a thoracotomy.
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