Proximal Landing Zone’s Impact on Outcomes of Branched and Fenestrated Aortic Arch Repair

<b>Background/Objectives:</b> The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). <b>Methods</b>: The STROBE statement was followed in order to conduct a single-center retrospective analysis of patients with nNPAL vs. NPAL managed, from 1 September 2011 to 30 June 2022, with f/bTEVAR. The primary outcomes were technical success, 30-day mortality and stroke. <b>Results</b>: A total of 83 patients with nNPAL vs. 126 patients with NPAL were included. Among the nNPAL group, 34 (39.7%) underwent previous aortic arch replacement and the remaining underwent an ascending aortic replacement. The nNPAL patients were more commonly treated for chronic dissections (nNPAL: 70.6% vs. NPAL: 21.6%, <i>p</i> < 0.001), presented a more proximal disease (zone 0: nNPAL: 27.7% vs. NPAL: 7.1%, <i>p</i> < 0.001; zone 1: nNPAL: 50.6% vs. NPAL: 10.2%, <i>p</i> < 0.001) and received more triple-branch devices (nNPAL: 16.9% vs. NPAL: 3.2%, <i>p</i> < 0.001), with a higher rate of Ishimaru zone 0 landing (nNPAL: 86.8% vs. NPAL: 51.6%, <i>p</i> < 0.001). Technical success (nNPAL: 98.8% vs. NPAL: 94.4%, <i>p</i> = 0.07) and 30-day mortality (nNPAL: 6.0%, vs. NPAL: 11.9%, <i>p</i> = 0.16) were similar. Stroke was lower among nNPAL patients (nNPAL: 4.8% vs. NPAL: 13.5%, <i>p</i> = 0.04). A multivariate regression analysis confirmed nNPAL as an independent protector for stroke (<i>p</i> = 0.002). Survival (log rank: <i>p</i> = 0.02) was higher within the nNPAL group at 24 months. <b>Conclusions</b>: f/bTEVAR in patients with nNPAL zone showed encouraging outcomes. Despite more proximal landing in zone 0, stroke was significantly lower when compared to NPAL patients.