A. Perkins1, K. Ramakrishnan1 1University of Tennessee Health Sciences Center, Surgery, Memphis, TN, USA
Introduction:
Vascular rings associated with a right aortic arch often present with an aberrant left subclavian artery arising from an aortic diverticulum, commonly known as Kommerell’s diverticulum (KD). Surgical management of this condition often involves resection of the KD and reimplantation of the aberrant left subclavian artery. This extensive procedure can be associated with a higher risk of complications. A less extensive surgical option is plication of the KD with/without concomitant aortopexy to achieve the same purpose as resection and reimplantation. The aim of this study is to explore the safety, efficacy, and clinical outcomes following plication of KD with or without aortopexy.
Methods:
This retrospective single center study included all patients less than 18 years of age who had undergone plication of Kommerrell’s diverticulum with/without aortopexy at the time of division of a vascular ring between January 2011 and Dec 2021. The outcome measures of interest were the need for re-operation for residual tracheal/bronchial compression or persistence of tracheal/esophageal obstructive symptoms. Chi-square test was used to compare groups.
Results:
44 patients met inclusion criteria and were included for analysis. 61% of subjects were male (27/44). The median age of the cohort was 3 years (Interquartile range 7.4). 22 patients underwent ligamentum division alone and 15 patients underwent ligamentum division and aortopexy without KD plication. 7 patients underwent plication of the diverticulum in addition to division of the ligamentum with (n=4) or without (n=3) aortopexy. At a median follow-up of 5 years, 8/44 (18%) had residual symptoms, 7 in the non-plication group (19%) and 1 in the plication group (14%) (p=0.77). The symptoms were predominantly that of asthma. 2 patients underwent reoperation for persistent symptoms 3 and 12 years after the initial operation, both of whom did not undergo plication at the initial operation (5%). One patient in the plication group developed post-operative chylothorax necessitating re-exploration.
Conclusion:
Plication of Kommerell’s diverticulum is a safe and effective operation without an increased risk of complications. The long-term outcomes are excellent following plication of the diverticulum with improved symptom resolution. This technique avoids the need for reoperation or reimplantation of the aberrant left subclavian artery and is the preferred alternative for treatment of children with right aortic arch and a vascular ring.