Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.
Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients.



During a 10-year period, consecutive patients treated by the ascending WT, SADB and TEVAR in zone 0 were included. All patients were considered at high risk for conventional surgery. Measured outcomes included perioperative deaths and morbidity, maximal aortic transverse diameter (TD) and its postoperative evolution, endoleak, survival, freedom from cardiovascular reinterventions, SADB freedom from occlusion and aortic valve function during follow-up. Median follow-up was 37.4 [mean = 34; range, 0-65; standard deviation (SD) = 20] months.



Twenty-six cases were included with a mean age of 71.88 ( r  = 56-87; SD = 8) years. A mean of 2.9 supra-aortic vessels (75) per patient was debranched from the ascending aorta. The mean time interval from WT/SADB and TEVAR was 29 ( r  = 0-204; SD = 48) days. TEVAR was associated with chimney and/or periscope grafts in 6 (23%) patients, and extra-anatomical supra-aortic bypasses were performed in 6 (23%) patients. Perioperative mortality was 7.7% (2/26). Neurological events were registered in 3 (11.5%) cases, and a reintervention was required in 3 (11.5%) cases. After the WT, the ascending diameter remained stable during the follow-up period in all cases. At mean follow-up, significant shrinkage of the arch/descending aorta diameter was observed. A type I/III endoleak occurred in 3 cases. At 5 years, the rates of survival, freedom from cardiovascular reinterventions and SADB freedom from occlusion were 71.7, 82.3 and 96%, respectively.



The use of the ascending WT, SADB and TEVAR in selected patients with complex thoracic aorta disease is safe and shows promising mid-term results at 3 years. The combination of these techniques could represent an alternative to the standard open surgical repair, especially in older patients or in patients unfit for cardiopulmonary bypass.
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.|University of Palermo, Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy.
Felice
F
Pecoraro
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Mario
M
Lachat
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Michael
M
Hofmann
New York University Medical Center, New York, NY, USA.
Neal S
NS
Cayne
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Lyubov
L
Chaykovska
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Zoran
Z
Rancic
Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
Gilbert
G
Puippe
Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
Thomas
T
Pfammatter
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Nicola
N
Mangialardi
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.|New York University Medical Center, New York, NY, USA.
Frank J
FJ
Veith
Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
Dominique
D
Bettex
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Francesco
F
Maisano
Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland.
Thomas A
TA
Neff
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors
Aneurysm; Arch; Ascending; Debranching; TEVAR; Wrapping