Deployment of proximal thoracic endograft in zone 0 of the ascending aorta: treatment options and early outcomes for aortic arch aneurysms in a high-risk population

Abstract

The hybrid approach enables the treatment of aortic arch disease in high-risk individuals. Long-term follow-up data are needed.

Zone zero hybrid arch exclusion versus open total arch replacement

“…A totally endovascular approach is being developed that uses custom-made devices (20), which raises the question of device durability. When we discuss hybrid arch operations that are comparable to open total arch repair, the hybrid procedure should involve debranching the supra-aortic arch vessels: if not all of them, then at least the innominate artery, the LCCA, or both (12,21,22). This approach avoids hypothermic circulatory arrest, CPB and aortic crossclamping.…”

“…In hybrid type II arch repair, CPB is required, the ascending aorta is replaced with a Dacron graft and the Dacron graft in the ascending aorta is considered zone 0. The hybrid procedure can be performed via median sternotomy or left thoracotomy, using the descending thoracic aorta for arterial inflow, if the median sternotomy is prohibitive (22). A series of extra-anatomic bypasses with arterial inflow to the iliac arteries have also been reported (23).…”

Thoracic Endovascular Aortic Repair for Challenging Aortic Arch Diseases Using Fenestrated Stent Grafts From Zone 0

“…Compared with conventional open repair, 1 benefit of the so-called debranching TEVAR for aortic arch aneurysms is that cardiopulmonary bypass and cerebral protection can be avoided. As this technique can be done using a commercially available SG and bypass grafting, which is a familiar procedure for vascular surgeons, debranching TEVAR has been widely accepted by many vascular surgeons and the feasibility of this procedure has been reported from many institutes [6][7][8]. While less invasive than traditional open repairs, hybrid surgical debranching procedures may still require sternotomy if BCA coverage is necessary.…”

Retrograde Ascending Aortic Dissection After Thoracic Endovascular Aortic Repair for Distal Aortic Dissection or With Zone 0 Landing: Association, Risk Factors, and True Incidence

“…We previously reported our experience with endograft landing in zone 0 [21]. We are extremely cautious when performing TEVAR in such patients.…”