Outcomes of Native Aorta vs Surgical Grafts for Zone 0 Proximal Thoracic Endograft Landing
Carla K Scott, Felipe L. Pavarino, Marilisa Soto Gonzalez, Jesus Porras-Colon, Carlos Timaran
University of Texas Southwestern Medical Center, Dallas, TX
Background: Total endovascular repair is less invasive and morbid treatment for aortic arch disease in patients unfit for open repair. Outcomes based on the type of proximal landing zone in zone 0 have not been defined. The purpose of this study was to assess the outcomes of native aorta (NA) vs. ascending aortic surgical graft (SG) replacement used as a landing zone for endovascular aortic arch repair. Methods: Between 2013 and 2022, patients that underwent zone 0 endograft implantation were evaluated in a retrospective single-center study. NA and prior SGs were compared. Chimney, hybrid procedures, and total endovascular repair were included. Primary endpoint included 30-day rates for mortality, stroke, and aortic-related major adverse events (MAE). Secondary endpoints included endograft oversize and ascending aorta enlargement. Chi-square and non-parametric t-tests were performed for statistical analysis. Results: Twenty-five patients (60% male) were identified: 8 with NA and 17 with SGs (mean age, 70.4 ± 6.3 and 63.9 ± 10.9 years-old, respectively). The median follow-up was 70 (interquartile range [IQR], 34.5-323.3) days for the NA group and 287 (IQR, 66.5-479) days for the SG group. No significant difference between groups was reported in the 30-day stroke rates (0 vs 2 [11.8%]; P=.34). Overall, one patient died from stroke complications in the first 30 days (0 vs 1 [5.9%]; P=.48). One death secondary to retrograde dissection in the NA group and one death related to aortic rupture in the SG group were reported after the 30-day period (37 and 196 days after, respectively). Graft oversizing was significantly greater in the NA group (24.7% vs 10.8%; P<.001), whereas ascending aortic enlargement was similar between both groups during the follow-up period (Table). Conclusions: In this series, native aorta and ascending aortic surgical grafts had similar results after thoracic endograft landing in zone 0. Despite greater oversizing used for native aorta, no difference in proximal endoleak development or aortic enlargement occurred. Larger series are required for further recommendations regarding optimal zone 0 landing zones.
| Variables | Native aorta (n=8) | Ascending graft (n=17) | P value |
| 30-day mortality | 0 | 1 (5.9) | .48 |
| 30-day stroke | 0 | 2 (11.8) | .31 |
| 30-day aortic-related MAE | 0 | 2 (11.8) | .31 |
| Development of proximal endoleak | 1 (12.5) | 2 (11.8) | .96 |
| Graft oversize, % | 24.7 (26 - 26.4) | 10.8 (9.3 - 9.8) | <.001 |
| Ascending aorta enlargement, mm | 1.6 (0.3 - 7.8) | 0 (-0.3 - 4.1) | .20 |
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