eComment. Addition of the frozen elephant trunk to the ascending aorta and aortic arch replacement in case of Stanford type A aortic dissection occurring in the presence of Kommerell's diverticulum

We read with great interest the manuscript by Tanaka et al. [1]. Authors presented the successful repair of the pathology in two consecutive stages [1]. An aberrant right subclavian artery is more frequently detected in the current era with advances in medical technologies and increased medical radiologic scannings. It is well known that Kommerell's diverticulum is a cause of oeosophageal and tracheal compression. Combination of frozen elephant trunk to acute type A Stanford dissection repair is a matter of debate. However, promising mid- to long-term results have been published in the literature in favour of repair [2,3]. When considering the authors' case, although initial surgical repair together with right subclavian artery debranching had been successful, we believe it had been incomplete, since the procedure failed to cover the aortic orifice of the right subclavian artery, resulting in risk of rupture at the origin of Kommerell's diverticulum or possible symptoms related to an aberrant right subclavian artery.

Another point is that when looking at the control 3-dimensional computed tomography after the second operation, if we are not wrong, we still see a Crawford type 3 thoracoabdominal aneurysm originating at the end of the stent graft and descending aorta??, although the authors state that remodeling of the descending aorta was satisfactory. We would appreciate it if the authors could kindly comment on the above aforementioned issues.

Conflict of interest: none declared.