Strategy and clinical outcomes of open surgical repair for adult Kommerell’s diverticulum: a retrospective cohort study and our 10-year experience

OBJECTIVES: To report our strategy and outcomes in open surgically treating adult Kommerell's diverticulum (KD) over the past decade. METHODS: 44 patiens who underwent open surgical repair for KD at our institution between 2015 and 2024 were enrolled. Patients were classified as aneurysm group (n = 25, 56.8%) or dissection (n = 19, 43.2%) group. Depending on the position and pathology, 1 of 4 procedures was performed: (1) descending aorta replacement and aberrant subclavian artery reconstruction; (2) total arch and partial descending aorta replacement; (3) thoracoabdominal aortic replacement; or (4) total arch replacement with frozen elephant trunk. Long-term prognosis and perioperative safety were analyzed. RESULTS: Early mortality and composite adverse events for the overall cohort were 13.6% and 20.5%, respectively, without significant differences between the aneurysm and dissection groups (8.0% vs 21.1%, P = 0.42; 16.0% vs 26.3%, P = 0.32). However, the dissection group had a higher rate of acute kidney injury (52.6% vs 20.0%, P = 0.02), longer mechanical ventilation (33.4 [13.2∼122.1] vs 14.2 [6.8∼22.7] h, P = 0.005), longer intensive care unit stay (5 [3∼10] vs 2 [1∼5] d, P = 0.001), and longer postoperative hospitalization (15 [14∼21] vs 10 [7∼18] d, P = 0.007). For the entire cohort, 5-year overall survival and freedom from aortic-related reintervention were 77.8% and 88.9%. Patients in the dissection group had significantly lower 5-year overall survival (61.2% vs 92.0%, P=0.022) and freedom from aortic-related reintervention rates (77.3% vs 100%, P=0.036). CONCLUSIONS: Open surgical strategy was selected arrording to the position and pathology of KD. Open surgery achieved acceptable early and long-term outcomes. Once KD progressed to dissection, the difficulty and risk of open surgery increased and the long-term prognosis was impaired.