Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair.

Objective: Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes.

Methods: From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.

Results: Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p<0.01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (OR 0.2; C.I. 0.1-0.6), while degenerative aneurysm with zone 0 or 1 involvement was predictive of post-operative stroke (OR 3.7; CI 1.2-11.8). At 4 years, survival for the N-AD group was 71.8±6.6%, and for the C-AD group was 71.5±6.5% (p=0.81).

Conclusion: Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing post-operative stroke.