TAA 8. Hybrid Repair Techniques for Kommerell Diverticulum, New Aortic Arch Classification, Early and Late Results

Objective: The aim of this study was to evaluate early and late results of hybrid repair techniques for Kommerell diverticulum (KD). Methods: All patients undergoing hybrid repair (thoracic endovascular aortic repair + supra-aortic debranching) for KD between 2009 and 2018 were included in this retrospective multicenter study (three Italian cen- ters). A proximal landing zone (PLZ) of at least 2 cm of healthy aorta was considered adequate for the deployment of a standard thoracic stent graft. The early end points were technical success, in-hospital mor- tality, and cerebrovascular events. Late outcomes included survival, rein- tervention, and patency of supra-aortic debranching. We proposed an embryogenetic anomaly-based aortic arch classification for PLZ evalua- tion to choose the most appropriate hybrid adjunct (Fig). Results: Sixteen patients with KD were included. According to the aforementioned classification, six patients (37.5%) required stent graft deployment in PLZ 0, nine (56.3%) in PLZ 1, and one (6.3%) in PLZ 2. Tech- nical success was achieved in all patients. One patient (6.3%) died in the hospital of posterior cerebral hemorrhage after a total debranching (PLZ 0). No other cerebrovascular event was registered. One patient (6.3%) re- ported an asymptomatic right subclavian artery-left subclavian artery bypass occlusion and required an early reintervention. The 30-day pri- mary assisted patency of supra-aortic debranching was 100% (Table I). Two type II endoleaks (12.5%) were detected at 1-month computed to- mography angiography. Further transient complications were registered in three cases: hemidiaphragm paralysis in one patient and recurrent laryngeal nerve paralysis in two patients. At a mean follow-up of 48 months, four patients died of non-aorta-related reasons and one right common carotid artery-right subclavian artery bypass lost its patency. Ten patients (62.5%) presented with aneurysmal sac shrinkage of at least 5 mm (Table II). Conclusions: Hybrid repair has been confirmed to be a safe and effec- tive approach for KD. Operative risk is mostly related to the invasiveness of the hybrid adjunct.