Long-Term Outcomes and Risk Factors after Hybrid Thoracic Endovascular Aortic Repair with Landing in Zones 1 and 2

Abstract

Background

This study aimed to examine the outcomes of zones 1 and 2 landing hybrid thoracic endovascular aortic repair (TEVAR) and to examine risk factors associated with poor outcomes.

Methods

From April 2014 to March 2024, 96 patients underwent zones 1 and 2 landing hybrid TEVAR for aortic arch pathologies (median age: 78 years). The primary endpoint was major adverse aorta-related events (late rupture/dissection and/or aorta-related reintervention). The secondary endpoint was type 1a endoleak. Outcomes were analyzed by Kaplan–Meier and log-rank tests; risk factors by Cox regression. Median follow-up was 3.0 years.

Results

The 30-day mortality rate was 2.1% and the stroke rate was 4.2%. The aortic events rate at 7 years was 38.1%. In multivariate analysis, age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.00–1.12; P = 0.023) and early era (HR 5.59; 95% CI, 1.23–25.3; P = 0.025) were significant risk factors for aortic events. Type 1a endoleak rates were significantly lower in the late-era group than in the early-era group (P = 0.003). The diameter of proximal landing zone in the early-era group was larger than that in the late-era group (P < 0.001); however, the oversizing rate of proximal stent grafts in the early-era group was smaller than that in the late-era group (P < 0.001). The aortic events and type 1a endoleak rates were significantly lower in the late-era group than in the early-era group (P = 0.003 and P = 0.011).

Conclusion

To prevent type 1a endoleak and aortic events, strict patient selection including preoperative measurement and surgeon skill are required. Hybrid TEVAR should be performed in an experienced facility.