Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR

Abstract

Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65-78 years), with a median follow-up period of 6.0 years (IQR, 2.8-9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided.

Keywords: aortic aneurysm; aortic arch aneurysm; dissecting; extra-anatomical bypass; hybrid arch repair; intracranial blood flow; thoracic endovascular aortic repair.

Figure 1

(A) Zone 1-landing hybrid TEVAR (zone 1). (B) Zone 2-landing hybrid TEVAR (zone 2).

Figure 2

Kaplan–Meier curve in the entire study group. (A) Cumulative survival. The cumulative survival rate at 10 years was 73.6% (95% CI: 64.7–80.9%). (B) Aorta-related death-free rates. The event-free rate at 10 years was 90.8% (95% CI: 77.2–96.7%). (C) Aortic event-free rate. The event-free rate at 10 years was 85.5% (95% CI: 79.4–90.1%).

Figure 2

Kaplan–Meier curve in the entire study group. (A) Cumulative survival. The cumulative survival rate at 10 years was 73.6% (95% CI: 64.7–80.9%). (B) Aorta-related death-free rates. The event-free rate at 10 years was 90.8% (95% CI: 77.2–96.7%). (C) Aortic event-free rate. The event-free rate at 10 years was 85.5% (95% CI: 79.4–90.1%).

Figure 3

Kaplan–Meier curve in the each groups. (A) Cumulative survival. The 10-year survival rates in the zone 1 and zone 2 groups were 66.8% (95% CI: 51.9–79.0%) and 78.0% (95% CI: 66.8–86.2%) (Log-rank p = 0.074), respectively. (B) Aorta-related death-free rates. The event-free rates at 10 years for the zone 1 and zone 2 groups were 97.6% (95% CI: 90.7–99.4%) and 99.2% (95% CI: 94.8–99.9%) (Log-rank p = 0.312), respectively. (C) Aortic event-free rates. The event-free rates at 10 years for the zone 1 and zone 2 groups were 81.4% (95% CI: 69.2–89.4%) and 87.9% (95% CI: 80.4–92.8%) (Log-rank p = 0.257), respectively.

Figure 3

Kaplan–Meier curve in the each groups. (A) Cumulative survival. The 10-year survival rates in the zone 1 and zone 2 groups were 66.8% (95% CI: 51.9–79.0%) and 78.0% (95% CI: 66.8–86.2%) (Log-rank p = 0.074), respectively. (B) Aorta-related death-free rates. The event-free rates at 10 years for the zone 1 and zone 2 groups were 97.6% (95% CI: 90.7–99.4%) and 99.2% (95% CI: 94.8–99.9%) (Log-rank p = 0.312), respectively. (C) Aortic event-free rates. The event-free rates at 10 years for the zone 1 and zone 2 groups were 81.4% (95% CI: 69.2–89.4%) and 87.9% (95% CI: 80.4–92.8%) (Log-rank p = 0.257), respectively.