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Midterm Outcomes Of Thoracic Branched Endografts For Zone 0 Aortic Arch Repair - Largest Single-center Experience To Date
Jovan N. Markovic, MD, Andrew M. Vekstein, MD, Lauren V. Huckaby, MD, Yas Sanaiha, MD, Chad G. Hughes, MD, Chandler A. Long, MD.
Duke University Medical Center, Durham, NC, USA.
Objectives: Favorable initial results, combined with FDA approval in June 2025 for Zone 0 aortic arch repair, have positioned thoracic branched endografts (TBE) as a less invasive option to open or traditional hybrid arch repair. This underscores the importance of longer-term outcomes. We report the largest single-center, midterm experience with Zone 0B repair using the Gore TBE device (W.L. Gore and Associates, Flagstaff, AZ).
Methods: We retrospectively reviewed all Zone 0B repairs with the TBE device performed at our institution since 2018. The primary endpoint was 30-day/in-hospital mortality and morbidity; secondary endpoints included technical success, branch-vessel patency, device complications, and reintervention. Kaplan-Meier analysis was used to estimate overall survival, aorta-related survival, and freedom from reintervention.
Results: Twenty-six patients (mean age, 64.8±8.5 years; 84.6% male) underwent Zone 0B repair with the 12 mm portal TBE device and a side branch for the innominate artery (Table I). All required supra-aortic cervical debranching, most often as a two-stage procedure (88.5%, n=23; single-stage, 11.5%, n=3) during the same hospitalization. Chronic dissection was the primary indication (76.9%), most frequently residual type B after prior type A repair (57.7%). Mean maximal aortic diameter was 6.0±1.2 cm. Technical success was 100%. Thirty-day/in-hospital mortality and stroke rates were 7.7% each (both n=2), with no cases of paraparesis/plegia or new dialysis. Mean postoperative length of stay, from supra-aortic cervical debranching to discharge, was 6.0±2.5 days. Late outcomes (mean follow-up 1.3±1.1 years) included 100% late branch patency; two endoleaks required reintervention (7.7%). Kaplan-Meier overall survival was 88.1% (95% CI, 76.4-100) at 1 year and 81.4% (95% CI, 65.8-100) at 2 years; aorta-related survival was 100%. Freedom from reintervention was 88.5% (95% CI, 74.1-100) and 70.8% (95% CI, 49.5-100) at 1 and 2 years, respectively.
Conclusion(s): Zone 0B arch repair with the TBE device demonstrates low early mortality and complication rates, durable branch-vessel patency, and acceptable midterm reintervention rates. Longer-term and multicenter data are needed to confirm safety and durability.
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