Abstract
OBJECTIVE: Kommerell diverticulum is an embryologic remnant of the dorsal fourth aortic arch. It often presents as part of vascular rings with a right dominant arch. Historically, these have been treated by dividing the ligamentum arteriosum. In recent years, some centers have adopted Kommerell diverticulum resection with subclavian translocation as a primary approach. However, no long-term studies have directly compared outcomes with simple ligamentum division. To address this, we conducted a 21-year dual-institution review comparing short- and long-term outcomes across surgical strategies. METHODS: A retrospective review of 131 patients who underwent vascular ring repair at 2 institutions was performed. Of these, 93 underwent simple ligamentum division and 38 underwent Kommerell diverticulum resection with subclavian artery translocation. Anatomic subtypes, symptoms, perioperative outcomes, and follow-up data were compared. RESULTS: There were no significant differences in intraoperative or postoperative complication rates between groups. Short-term symptoms such as dyspnea (P = .56), cough (P = .72), and dysphagia (P = .55) were comparable. Rates of recurrent laryngeal nerve injury (P = .67), chylothorax (P = .18), infection (P = .62), hospital stay (P = .49), and 30-day readmission (P = .63) were also similar. Four patients in the simple division group required reoperation; none did in the Kommerell diverticulum group (P = .32). Symptom recurrence at long-term follow-up did not differ significantly (P = .30). CONCLUSIONS: Kommerell diverticulum resection with arterial translocation is safe and effective, with favorable outcomes comparable to simple ligamentum division.