title: 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: OBJECTIVE
  Open repair of aortic arch aneurysms can be technically challenging. Hybrid approaches have been developed to facilitate arch repairs and improve their clinical outcomes in high-risk patients. We examined treatment options and early outcomes in patients whose thoracic endografts were deployed to include Zone 0.
  
  
  METHODS
  Between 2005 and 2011, a hybrid approach in which the endograft was deployed in the ascending aorta was used in 29 patients (median age 67 years, range 32-85 years). The indication for surgery was saccular arch aneurysm in 11 patients (37.9%), fusiform arch aneurysm with or without involvement of the proximal descending aorta in 10 (34.5%), proximal Type I endoleak after endovascular repair of the descending aorta in 5 (17.2%), chronic Type III (Type B) aortic dissection with aneurysmal arch formation in 2 (6.9%) and acute Type I (Type A) dissection with prior repair of an extent I thoracoabdominal aneurysm in 1 (3.4%). Six patients (20.7%) had previously undergone a sternotomy. One-, two- or three-branch aortobrachiocephalic de-branching, with or without concomitant heart surgery, was performed in 28 patients and extra-anatomic bypass in 1.
  
  
  RESULTS
  Two patients (6.9%) died during postoperative hospitalization. Overall survival during the follow-up period (median 411 days) was 79.3%. Five neurological events occurred: one extensive stroke, two minor strokes (10.3%) and two episodes of paraparesis (6.9%), one with partial recovery and one with full recovery.
  
  
  CONCLUSIONS
  The hybrid approach enables the treatment of aortic arch disease in high-risk individuals. Long-term follow-up data are needed.
authors.affiliation: Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77030, USA. opsmile01@aol.com
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.forename: Roberto D
authors.initials: RD
authors.lastname: Cervera
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aorta; Aortic arch aneurysm; Hybrid procedures; Thoracic; Zone 0