Abstract 4373396: Treatment and prognosis of aortic diseases related to Kommerell diverticulum: single-center retrospective cohort study

Background and Objective: Kommerell's diverticulum is a special type of proximal subclavian artery aneurysm that is associated with the aberrant subclavian artery. Although most patients are asymptomatic, there is a high risk of aortic rupture and aortic dissection. This study aimed to investigate the clinical characteristics, treatment strategies, and long-term prognosis of this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) through a single-center retrospective study, providing valuable support for clinical decision-making. Methods: Patient data were collected from the medical records system from February 2011 to April 2022 for patients who had computer tomography scan reports indicating Kommerell's diverticulum and underwent intervention at our institution. A total of 76 adult patients aged 18 years and above with Kommerell's diverticulum were included in this study, of which 48 had concomitant aortic dissection and 28 without. Results: The overall early postoperative mortality rate for the included cases in this study was 9.2% (7/76 cases), with a 30-day mortality rate of 12.5% (6/48 cases) for the group with concomitant aortic dissection and 3.6% (1/28 cases) for the non-aortic dissection group. The median follow-up time for all included patients in this study was 4.0 years. Preoperative coronary artery atherosclerotic heart disease was identified as a risk factor associated with surgical mortality (OR=3.15, P=0.0163). Central nervous system complications occurred in 10 patients (13.2%), and respiratory system complications occurred in 4 patients (5.3%), with both cases in the group with concomitant aortic dissection resulting in postoperative death within 30 days due to compression of the right main bronchus by the aneurysm, leading to lung infection and respiratory failure. The 3-year, 5-year, and 7-year survival rates for the group with concomitant aortic dissection were 82.5%, 79.7%, and 75.1%, respectively, while the survival rates for the non-aortic dissection group were all 88.9%. Conclusion: The treatment approach for patients with this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) should be based on comprehensive evaluation including age, symptoms, and imaging findings. Attention should be paid to the relationship and compression of the aortic dissection with the right main bronchus in patients with Kommerell's diverticulum and a right-sided aortic arch.