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Case Reports
. 2022 Dec 17;1(2):285-288.
doi: 10.1016/j.atssr.2022.12.005. eCollection 2023 Jun.

Hybrid Frozen Elephant Trunk for Single-Stage Kommerell Diverticulum and Type A Dissection Repair

Santiago Besa  1 , Fadi Hage  1 , Aashish Goela  2 , Michael W A Chu  1
Affiliations
Case Reports

Hybrid Frozen Elephant Trunk for Single-Stage Kommerell Diverticulum and Type A Dissection Repair

Santiago Besa et al. Ann Thorac Surg Short Rep. .

Abstract

Treatment of Kommerell diverticulum is challenging, often involving multistage repair to achieve successful exclusion of the aneurysmal diverticulum, division of the vascular ring to release compression, and reconstruction of the aberrant subclavian artery to maintain arm perfusion. A well-planned, elective repair remains the optimal scenario; however, emergency presentation can be extremely challenging, particularly in acute aortic dissection. We describe an innovative, single-stage approach using a novel multibranched hybrid arch frozen elephant trunk prosthesis to achieve complete repair of a Kommerell diverticulum and aberrant right subclavian artery in a patient who presented with an acute type A aortic dissection.

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Figures

Figure 1
Figure 1
(A) Preoperative computed tomography (CT) scan showing an acute type A aortic dissection. (B) Preoperative CT scan showing the entry tear originating at the level of the Kommerell diverticulum. (C) Preoperative coronal CT reconstruction showing the origin and course of the aberrant right subclavian artery. (D) Postoperative 3-dimensional CT reconstruction showing the hybrid frozen elephant trunk and all its branches and the thrombosed Kommerell diverticulum.
Figure 2
Figure 2
Intraoperative images. (A) The aberrant right subclavian artery, deep in the mediastinum (∗). (B) The deployment of the hybrid frozen elephant trunk prosthesis in zone 2. (C) Completed right carotid limb and preparation for anastomosis of the aberrant right subclavian artery graft to the right carotid limb. (D) Final result.
See this image and copyright information in PMC

References

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