Midterm outcomes of zone 0/1 landing hybrid thoracic endovascular aortic repair procedures

Aim: The combination of endovascular and open surgical techniques in hybrid procedures represents an innovative therapeutic strategy for the management of aortic arch diseases. Despite reported short-term results, the procedural success in years remains unclear and requires more research. We investigated the mid-term results of our hybrid thoracic endovascular aortic repairs (TEVAR) in zone 0/1. Material and Methods: From May 2016 to December 2024, thirteen patients with aortic arch diseases who were unsuitable for open surgery and who underwent zone 0/1 landing hybrid TEVAR procedures were enrolled. The patients treated with in situ fenestrations, physician-modified techniques and periscope graft techniques were excluded. Demographics, aortic pathologies, operative features, survival outcomes, and complications in years were analyzed. Results: We performed hybrid TEVAR procedures for eight patients presenting with residual type A aortic dissection – aneurysm, four with an arch aneurysm and one with Kommerell's diverticulum. The mean follow-up was 32 months (range: min 1 year-max 5 years). The early mortality rate was 15% (2 patients), and the overall mortality rate was 46% (6 patients). Two cerebrovascular events and one retrograde aortic dissection were observed. Renal impairment, endoleak, and graft migration were absent. Conclusion: Hybrid TEVAR in Zones 0 and 1 could be applicable and acceptable for complex aortic arch pathologies in high-risk and frail patients who are inappropriate for open surgery. Aiming to achieve a secure proximal landing zone with a Hybrid approach can improve the results.