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Hybrid Repair of Kommerells Diverticulum Jahanzaib Idrees MD, Suresh Keshavamurthy MD, Sreekumar Subramanian MD, Daniel G. Clair MD, Lars G. Svensson MD, Eric E. Roselli MD Heart and Vascular Institute

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Kommerrels Diverticulum Right sided Aortic Arch Ligamentum Arteriosum Completing Vascular ring Frequently co-exists with aberrant subclavian artery & right sided aortic arch

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Objectives To describe hybrid repair techniques To evaluate clinical outcomes

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Patients August 2005 to October 2010 Mean Age 57 25 N=10 Elephant Trunk with Endo completion N=4 Frozen Elephant Trunk N=3 TEVAR with Cervical Debranching N=3

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Elephant Trunk With Endo Completion Stage IStage I I N=4

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Frozen Elephant Trunk N=3 + Ascending Subclavian Bypass Ligamentum divided Stentgraft delivered antegrade; sutured proximally Posterior view; subclavian coiled

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TEVAR with Cervical Debranching N=3 Left Carotid subclavian bypass Right Carotid subclavian bypass Stent Graft

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Subclavian Revascularization RevascularizationC-S BypassAsc-S Bypass Unilateral (N=6)42 Bilateral (N=4)31 TimingN Preoperative4 Intraoperative3 Postoperative3

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Results No Mortality 1 Stroke Post TEVAR, mild dysarthria and unilateral leg weakness 2 Type II endoleaks 1 requiring Subclavian embolization No paraplegia No Respiratory failure No Renal failure No Reoperation for bleeding

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Conclusions Hybrid repair of Kommerells diverticulum is safe and effective. Type of intervention is based on patients anatomy and co-morbid conditions.