Hybrid Repair of Kommerell’s D iverticulum

Hybrid Repair of Kommerell’s Diverticulum

Jahanzaib Idrees MD, Suresh Keshavamurthy MD, Sreekumar Subramanian MD, Daniel G. Clair MD, Lars G. Svensson MD, Eric E. Roselli MD

Heart and Vascular Institute

Kommerrel’s Diverticulum

Kommerrel’s Diverticulum

Right sidedAortic Arch

Ligamentum ArteriosumCompleting Vascular ring

• Frequently co-exists with aberrant subclavian artery & right sided aortic arch

Objectives

• To describe hybrid repair techniques• To evaluate clinical outcomes

PatientsAugust 2005 to October 2010

Mean Age 57 ± 25

N=10

Elephant Trunk

with Endo completion

N=4

FrozenElephant

Trunk N=3

TEVAR with Cervical

Debranching N=3

Elephant Trunk With Endo Completion

Stage I Stage I I

N=4

Frozen Elephant TrunkN=3

+ Ascending Subclavian Bypass

Ligamentum divided

Stentgraft delivered antegrade; sutured proximally

Posterior view; subclavian coiled

TEVAR with Cervical DebranchingN=3

Left Carotid subclavian bypass

Right Carotid subclavian bypass

Stent Graft

Subclavian RevascularizationRevascularization C-S Bypass Asc-S Bypass

Unilateral (N=6) 4 2

Bilateral (N=4) 3 1

Timing N

Preoperative 4

Intraoperative 3

Postoperative 3

Results• No Mortality• 1 Stroke

Post TEVAR, mild dysarthria and unilateral leg weakness

• 2 Type II endoleaks1 requiring Subclavian embolization

• No paraplegia• No Respiratory failure• No Renal failure• No Reoperation for bleeding

Conclusions

Hybrid repair of Kommerell’s diverticulum is safe and effective.

Type of intervention is based on patient’s anatomy and co-morbid conditions.