Vascular Rings in Adults: Outcome of Surgical Management

Limited data exist on the management of vascular rings (VR) in adults. We reviewed our experience of surgical treatment of these patients. All adult patients with VR (n = 65) who underwent VR repair (mean age, 45 ± 16 years; 33 women [51%]) from January 1972 to January 2018 were retrospectively revi...

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Vydáno v:The Annals of thoracic surgery Ročník 108; číslo 4; s. 1217
Hlavní autoři: Saran, Nishant, Dearani, Joseph, Said, Sameh, Fatima, Benish, Schaff, Hartzell, Bower, Thomas, Pochettino, Alberto
Médium: Journal Article
Jazyk:angličtina
Vydáno: Netherlands 01.10.2019
Témata:
Adult
Age Factors
Deglutition Disorders - diagnostic imaging
Deglutition Disorders - etiology
Female
Humans
Male
Middle Aged
Patient Selection
Retrospective Studies
Sternotomy
Survival Rate
Thoracotomy
Treatment Outcome
Vascular Ring - complications
Vascular Ring - mortality
Vascular Ring - surgery
ISSN:1552-6259, 1552-6259
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Shrnutí:Limited data exist on the management of vascular rings (VR) in adults. We reviewed our experience of surgical treatment of these patients. All adult patients with VR (n = 65) who underwent VR repair (mean age, 45 ± 16 years; 33 women [51%]) from January 1972 to January 2018 were retrospectively reviewed. Anatomic variants were right arch with aberrant left subclavian artery (SA) and Kommerell diverticulum (KD) in 22 (34%), left arch with aberrant right SA and KD in 20 (31%), double aortic arch in 12 (18%), right arch with mirror imaging and persistent ligamentum off KD in 7 (11%), and others in 4 (6%). Indications for operation included dysphagia in 43 (63%), respiratory symptoms in 28 (43%), aneurysmal KD in 12 (18%), and dissection/rupture in 7 (11%). KD was found in 51 patients (78%). The surgical approach included left thoracotomy in 50 (77%), right thoracotomy in 7 (11%), sternotomy in 5 (8%), and hybrid repair in 3 (5%). A 2-stage repair with carotid-SA transposition, followed by transthoracic KD excision, was done in 51% of aberrant SA (n = 23). There was 1 early death. Morbidity included recurrent laryngeal nerve injury in 5 (8%) and chylothorax in 3 (5%). Symptomatic improvement occurred in 97%. Survival was 96.1%, 85.0%, and 73.4% at 1, 5, and 10 years, respectively. Dysphagia recurred in 9 (14%), which included 7 (11%) with esophageal dysmotility. Repair of VR in adults can be performed safely. Dysphagia is the most common symptom and improves in most after repair. Excision of the KD and aberrant vessel is the preferred approach to prevent acute aortic events or recurrent symptoms. Early operation should be considered with esophageal compression to avoid late dysmotility.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1552-6259
1552-6259
DOI:10.1016/j.athoracsur.2019.04.097