Long-term Outcomes Following Thoracoscopic Division of Vascular Rings

We evaluate long-term symptomatic improvement in vascular ring patients who underwent thoracoscopic division at a single quaternary pediatric surgery center. All pediatric patients who underwent vascular ring division without Kommerell's diverticulum resection between 01/2007–12/2022 were included. Surgeries were performed by pediatric general and thoracic surgeons. Patient demographic and clinical characteristics were obtained from retrospective chart review. Data on long-term symptomatic improvement were collected with structured telephone interviews. 60% of patients were male. Median age at operation was 24 months (IQR: 11, 60 months) with a median weight of 11.3 kg (IQR: 8.7, 19.8 kg). All patients were symptomatic preoperatively with dysphagia being the most frequent complaint (42%), followed by chronic cough (21%). Of 41 patients eligible for the long-term follow-up survey, 8 patients with a primary diagnosis of a double arch with an atretic segment in the non-dominant arch and 9 with a right dominant arch with left ligamentum arteriosum and aberrant left subclavian artery (LSCA) were contacted and consented for participation. Median interval from surgery to survey completion was 95 months (IQR 28, 135 months). Most patients had no, or only minor, symptoms related to breathing and swallowing at the time of long-term follow-up. 88% of patients experienced postoperative symptom improvement, and only one patient reported worsening of symptoms over time. Division of an atretic arch and/or ligamentum for patients with an aberrant LSCA without Kommerell's resection may be adequate to ensure long-term improvement of breathing and swallowing problems attributable to vascular rings. Level IV. •What is currently known about this topic? In children with vascular rings, surgery to divide the non-dominant arch and ligamentum arteriosum in the case of double arch or the ligamentum alone for right dominant arch with LSCA anomalies is the treatment of choice for symptomatic patients; however, management of Kommerell's diverticula remains controversial.•What new information is contained in this article? We report outcomes of pediatric patients who underwent thoracoscopic division of vascular rings without concomitant Kommerell's diverticula resection. At a median follow-up of 95 months, 88% of surveyed patients' respiratory and gastrointestinal symptoms had improved, suggesting that diverticulectomy may not be required for symptom resolution.