title: Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum.
abstract: BACKGROUND
  Surgery in patients with Kommerell diverticulum (KD) is controversial. Although the presence of symptoms is an accepted indication, the KD itself may be a risk factor for dissection and rupture, although size criteria for operation are undefined.
  
  
  METHODS
  A retrospective review of 19 adult patients who underwent surgical treatment of KD between March 2004 and June 2013 was performed. Mean age was 48 years (range, 32 to 68 years). Fifteen patients were female, 15 were symptomatic, and 13 had a right aortic arch. Sixteen patients with aberrant subclavian artery underwent a two-stage procedure involving subclavian-common carotid artery transposition or bypass followed by aortic resection, including origin of the KD, with interposition graft reconstruction. Aortic resection was performed with left heart bypass (n = 10) or deep hypothermic circulatory arrest (n = 9).
  
  
  RESULTS
  There were no deaths or strokes. Complications after aberrant subclavian artery revascularization were transient ptosis (n = 3), graft occlusion (n = 1), recurrent laryngeal nerve injury (n = 1),phrenic nerve injury (n = 1), and reintubation (n = 1). Complications after aortic resection were intraoperative type A dissection (n = 1), phrenic nerve injury (n = 1), chylothorax (n = 1), and transient neurologic dysfunction (n = 1). Mean hospital stay after aberrant subclavian artery revascularization was 2 ± 2 days and after aortic resection, 6.4 ± 2.4 days. Of 18 available pathology specimens, all 18 showed medial degeneration. Mean follow-up was 3.3 years.
  
  
  CONCLUSIONS
  This is the largest reported single-center experience with the surgical management of KD in adults, verifying its safety and efficacy. The high percentage of KD with medial degeneration suggests asymptomatic patients with an enlarged KD also may benefit from resection.
authors.affiliation: Division of General Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Cambria
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Baker
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: LaMuraglia
authors.affiliation: Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: James R
authors.initials: JR
authors.lastname: Stone
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: tmacgillivray@partners.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000151:congenital*; D004240:Diverticulum / Q000151:congenital* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities