Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia.
School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
J Cardiothorac Surg. 2023 Mar 24;18(1):93. doi: 10.1186/s13019-023-02156-x.
Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches.
From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3).
Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.
Kommerell 动脉瘤是 3-8%Kommerell 憩室病例中发现的囊状或梭形扩张。已有 6%的非夹层破裂率的报道。如果破裂，通常会给予紧急手术矫正。然而，关于这种急性情况下最佳手术方法的证据很少。在本病例报告系列中，我们旨在描述我们用杂交急诊手术方法治疗 1 型非夹层破裂 Kommerell 动脉瘤的经验。
从 2005 年 1 月至 2020 年 12 月，确定了 3 例需要紧急手术修复的 1 型非夹层破裂 Kommerell 动脉瘤病例。平均年龄为 66.67±7.76 岁，3/3 为男性。最常见的症状是不典型胸痛、呼吸困难和头痛（2/3）。平均动脉瘤直径为 63.67±5.69mm。冷冻象鼻是首选的手术方法（2/3）。非冷冻象鼻患者接受了一种杂交手术，包括主动脉弓去分支和 Zone-2 支架移植术。我们发现平均夹闭时间为 140±60.75 分钟，心脏停搏时间为 51.33±3.06 分钟，住院时间为 13.67±5.51 天。最常见的并发症是手术部位感染和休克（2/3）。只有 1 例患者死亡（1/3）。
对于非夹层破裂的 Kommerell 动脉瘤，管理证据很少。需要更多的、有力的和广泛的研究。适当手术方法的选择具有挑战性，每个患者都应个体化。冷冻象鼻在我们中心需要紧急手术修复的患者中是可行的。然而，也可以进行其他杂交或开放手术。
