Key result
Branched TEVAR resulted in similar in-hospital mortality (0% vs. 3.4%, p=1.00) compared to hybrid TEVAR, but significantly reduced operative time (220 vs. 279 min, p<0.001).
Why the study?
To verify whether branched TEVAR (bTEVAR) is an effective and more minimally invasive treatment compared with hybrid TEVAR (hTEVAR) for aortic arch diseases in landing zone 0.
Does branched TEVAR improve outcomes and reduce invasiveness compared to hybrid TEVAR in patients with aortic arch diseases requiring Zone 0 landing?
Cohort (n=54)
No
Does branched TEVAR improve outcomes and reduce invasiveness compared to hybrid TEVAR in patients with aortic arch diseases requiring Zone 0 landing?
Branched TEVAR offers a less invasive alternative to hybrid TEVAR for Zone 0 landing, significantly reducing operative time and hospital stay with comparable mortality and mid-term outcomes.
Branched TEVAR was associated with shorter operative time and similar mortality; hypothesis-generating and leaves open confirmation in randomized trials.
Background: Zone 0 landing thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch diseases has become a topic of interest. This study aimed to verify whether branced TEVAR (bTEVAR) is an effective and a more minimally invasive treatment by comparing the outcomes of bTEVAR and hybrid TEVAR (hTEVAR) in landing zone 0. Methods: This retrospective, single-center, observational cohort study included 54 patients (bTEVAR, n = 25; hTEVAR, n = 29; median age, 78 years; median follow-up period, 5.4 years) from October 2012 to June 2018. The logistic Euro-SCORE was significantly higher in the bTEVAR group than in the hTEVAR group (38% vs. 21%, p < 0.001). Results: There was no significant difference the in-hospital mortality between the bTEVAR and hTEVAR groups (0% vs. 3.4%, p = 1.00). The operative time (220 vs. 279 min, p < 0.001) and length of hospital stay (12 vs. 17 days, p = 0.013) were significantly shorter in the bTEVAR group than in the hTEVAR group. The 7-year free rates of aorta-related deaths (bTEVAR [95.5%] vs. hTEVAR [86.9%], Log-rankp = 0.390) and aortic reintervention (bTEVAR [86.3%] vs. hTEVAR [86.9%], Log-rankp = 0.638) were not significantly different. Conclusions: The early and mid-term outcomes in both groups were satisfactory. bTEVAR might be superior to hTEVAR in that it is less invasive. Therefore, bTEVAR may be considered an effective and a more minimally invasive treatment for high-risk patients.
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Kudo et al. (2022) conducted a cohort in aortic arch diseases (n=54). Branched thoracic endovascular aortic repair (bTEVAR) vs. Hybrid thoracic endovascular aortic repair (hTEVAR) was evaluated on in-hospital mortality (p=1.00). Branched TEVAR resulted in similar in-hospital mortality (0% vs. 3.4%, p=1.00) compared to hybrid TEVAR, but significantly reduced operative time (220 vs. 279 min, p<0.001).
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