Abstract

Objectives: This study aimed to compare perioperative and long-term outcomes of zone 0 versus zone 1 hybrid aortic arch repair in a Vietnamese cohort.
Methods: A retrospective–prospective cohort study of 117 patients undergoing hybrid arch repair at a single tertiary center from 2014 to 2023. Hybrid arch repair was performed in patients with thoracic aortic diseases, including aneurysm, dissection, intramural hematoma, penetrating aortic ulcer, and blunt thoracic aortic injury. Patients were stratified by proximal landing zone 0 or 1. Perioperative outcomes, complications, and long-term survival were analyzed using Kaplan–Meier and Cox regression methods.
Results: Thirty-four patients underwent zone 0 repair and 83 underwent zone 1 repair. The median follow-up duration was 40.7 ± 29.6 months (range 0.2–122.6 months), with a 97.4% follow-up completion rate. The overall 30-day mortality rate was 9.0%, significantly higher in the zone 0 group (26.5%) compared to zone 1 (6.0%; p = 0.002). Stroke occurred in 6.0% of patients. The overall survival rates at 1, 3, 5, and 10 years were 96.2%, 89.6%, 86.9%, and 75.0%, respectively. At 10 years, survival in zone 0 was 66.8% versus 82.5% in zone 1 (p = 0.019). Retrograde type A dissection was observed in 2.6% of patients, one in zone 0. Late complications, including endoleak type Ia (1.7%) and graft occlusion (0.9%), were infrequent and not statistically different between groups.
Conclusions: Zone 1 hybrid arch repair was associated with better early and long-term outcomes than zone 0. These findings support preferential use of zone 1 landing when anatomically feasible and underscore the importance of proximal landing zone selection in optimizing hybrid TEVAR outcomes in high-risk populations.

Key words: Hybrid procedure, thoracic aortic diseases, endovascular repair