The NAVIGATE registry: Early endovascular repair of the ascending aorta with the nexus ascending module.

OBJECTIVES: Open repair remains the standard for ascending aortic pathology but carries high morbidity in frail or inoperable patients. This study evaluates the feasibility and early outcomes of endovascular repair using the Nexus Ascending Module, a CE-marked device designed for zone 0. METHODS: NAVIGATE is a retrospective multicentre European registry including eight high-risk patients treated between 2023 and 2025 across six tertiary centres. All had focal zone 0 pathology and were deemed unsuitable for open repair. Procedures were planned with ECG-gated CT angiography and performed transfemorally. Technical success, perioperative complications, 30-day mortality, and follow-up outcomes were assessed. RESULTS: Median age was 80.0 years (IQR: 59.5-80.5), and 87.5% had prior cardiac surgery. The median EuroSCORE II was 24.0% (IQR 19.7-44.0%). Pathologies included Contained rupture/pseudoaneurysm (n = 4), mycotic pseudoaneurysm (n = 3), and type A DeBakey II dissection (n = 1). Technical success was achieved in all patients; two required immediate overlapping stent-grafts for complete sealing. No stroke, valve dysfunction, coronary compromise, tamponade, type I/III endoleak, conversion to surgery, or in-hospital/30-day mortality occurred. One access-related complication was observed.Median ICU and hospital stays were 1 and 5 days. At a median follow-up of 15 months (IQR 12-24), no aortic reinterventions or device-related complications occurred. Two patients died from respiratory disease (12 months) and persistent infection (4 months). CONCLUSIONS: This small multicentre case series suggests that endovascular repair of isolated zone 0 ascending pathology using the Nexus Ascending Module is technically feasible in highly selected patients; however, these findings are preliminary and hypothesis-generating.