852 Total Endovascular Aortic Arch Repair: Is It for Everyone and Where Is Its Evidence?

Background Open total arch replacement (TAR) remains the mainstay management strategy for thoracic aortic arch pathologies. TAR evolved from the 2-stage conventional elephant trunk (CET) technique to the hybrid frozen elephant trunk (FET) which combined open surgical repair (OSR) with thoracic endovascular aortic repair (TEVAR) into a 1-stage procedure. Although FET has been able to achieve better outcomes than CET, it is still associated with complications requiring secondary reintervention. Consequently, FET is being overtaken by new generations of TEVAR devices for endoarch repair. Total endoarch repair (TER) is currently indicated in patients deemed high-risk for open surgery; however, it has shown strong potential for becoming the gold standard treatment for aortic arch pathologies. Therefore, this review aimed to highlight the evolution of aortic arch repair, focusing on TER device development, intervention criteria, and clinical outcomes. Method A comprehensive literature search of various databases (PubMed, Google Scholar, EMBASE, Scopus, and ResearchGate) was conducted and papers published as of July 2023 were included. Results Upon comprehensively searching the literature, the technical success of TER ranged from 91%-100%, mortality 0%-19%, stroke 0%-16.7%, and reintervention 0%-30.3%, using different commercially available endografts. Conclusions TER represents the future of aortic arch repair with comparable clinical outcomes to FET. Given its novelty, further studies with larger cohorts and longer follow-up periods are necessary. Additionally, studies directly comparing arch OSR to TER are warranted to determine superiority.