To summarize the experience of surgical treatment of Kommerell diverticulum and related aortic arch and descending thoracic aneurysm.

From November 2012 to January 2018, 6 patients(5 males, and 1 female), with median age of 46(from 14 to 63) years old, underwent graft replacement of involved aortic segment in our institution . All the patients had symptom including persistent backache(3 patients), hoarseness(1 patient), recurrent pneumonia(1 patient) and hemoptysis(1 patient). All the patients had right-sided aortic arch and aberrant left subclavian artery. True aneurysm occurred in 5 patients and pseudoaneurysm occurred in 1 patients. The median diameter of the aneurysms was 65mm(53-80 mm). Two kinds of approaches were used: left posterior thoracotomy(2 patients) and median sternotomy plus right posterior thoracotomy(4 patients). The left posterior thoracotomy was achieved through the fourth and seventh intercostal space with excellent exposure of the whole descending thoracic aneurysm. For each patient, the aneurysm was resected with the proximal and distal aortic segment were clamped and the ligamentum arteriosum were divided. A branched woven polyester graft was used to reconstruct the descending thoracic aneurysm. 1 or 2 subclavian arteries were replaced with 10mm collagen-impregnated polyester grafts. One patient received total arch and partial descending thoracic aorta replacement with reconstruction of 3 supra-arch vessels.

There was no operative mortality. The median clamping time of descending aorta was 28(22-61) minutes, the median mechanical ventilation time was 33.5(6-485) hours, the median ICU stay was 4(1-31) days. One patient died from central respiratory and circulatory failure due to acute brain stem infarction on the 31st day after operation. One patient suffered from reentry to ICU due to hyoxemia and recovered through expectant treatment. One patient had critical illness polyneuropathy after operation and received mechanical ventilation therapy for 485 hours, he recovered through neurotrophic drug treatment. The median follow-up time is 5(1-46) months. 5 patients lived with no discomfort and the CT scans during follow-up time showed good morphology and patency of graft and branches. There was no anastomotic leakage and pseudoaneurysm.

Surgical treatment of Kommerell diverticulum is safe and effective. Subclavian artery should be reconstructed.

Aortic aneurysm; Kommerell diverticulum; Cardiac surgical procedunes