title: Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry.
abstract: BACKGROUND
  Landing zone 0, defined as a proximal landing zone in the ascending aorta, remains the last frontier to be taken. Midterm results of total arch rerouting and thoracic endovascular aortic repair (TEVAR) extending into landing zone 0 remain to be determined.
  
  
  METHODS
  From 2003 to 2011, 66 patients (mean age, 70 years; 68% men) presenting with pathologic conditions affecting the aortic arch (atherosclerotic aneurysms [n = 48], penetrating ulcers [n = 6], type B dissections [n = 6], type B after type A dissections [n = 5], and anastomotic aneurysm [n = 1]) were treated in 5 participating centers. Of these 66 patients, only 12% would have been deemed suitable for any kind of conventional surgical repair because of multisegmental aortic disease or comorbidities.
  
  
  RESULTS
  In-hospital mortality was 9%. Retrograde type A dissection was observed in 3% of patients. The assisted type I and type III endoleak rate was 0%. Stroke was seen in 5% of patients. Permanent paraplegia was observed in 3% of those studied. Median follow-up was 25 months (8-41 months). There was 1 late type Ib endoleak, which was followed by watchful waiting. Five-year survival was 72%. Five-year aorta-related survival was 96%. No aorta-related reintervention had to be performed in the segments treated.
  
  
  CONCLUSIONS
  Midterm results of total arch rerouting and TEVAR extending into landing zone 0 are excellent in regard to aorta-related survival and freedom from aorta-related reintervention. Retrograde type A dissection, potentially related to compliance mismatch between the ascending aorta and the stent-graft, warrants further attention. Extended application of this strategy augments therapeutic options in a group of patients who are not suitable candidates for conventional therapy.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. martin.czerny@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Juerg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
authors.forename: Guido
authors.initials: G
authors.lastname: Gelpi
authors.forename: Tanja
authors.initials: T
authors.lastname: Friess
authors.forename: Josef
authors.initials: J
authors.lastname: Klocker
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Patrick
authors.initials: P
authors.lastname: Moeller
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male