Three-branched in situ laser fenestration for the endovascular repair of total aortic arch disease: A retrospective analysis of 5-year outcomes.

Abstract

To evaluate the 5-year long-term outcomes of in situ laser fenestration (ISLF)-assisted thoracic endovascular aortic repair (TEVAR) for acute type A dissection involving zone 0 with all three supra-aortic branches reconstructed. This single-center, retrospective consecutive series (2014-2021) included 152 zone 0 acute type A dissection patients treated with three-branched ISLF-assisted TEVAR. In the same timeframe, 286 contemporaneous patients at our institution were treated mainly with open or hybrid repair (not analyzed here). The primary end point was immediate technical success. Secondary end points included branch-stent patency at 1, 2, and 5 years and complete false-lumen thrombosis in the stent-covered segment at 1, 2, and 5 years, as well as postoperative complications. ISLF-assisted TEVAR with triple-branch reconstruction was performed in all 152 patients; immediate technical success was 95.4%. Within 30 days, 6 deaths (3.9%), 11 strokes (7.2%), 5 cases of spinal cord ischemia (3.3%), and 4 proximal stent-induced dissections (2.6%) were observed; no distal stent-induced dissections occurred. Long-term follow-up was available in 94.7% of patients (144/152). At a mean of 60 months (range, 12-72 months), branch-stent patency was 96.1% at 1 year, 95.0% at 2 years, and 94.7% at 5 years. Complete false-lumen thrombosis in the covered segment was 89.6%, 84.7%, and 82.6% at 1, 2, and 5 years, respectively. Over 5 years, all-cause mortality was 7.9% (n = 12) and reintervention 12.5% (n = 18). In this single-center cohort, ISLF-assisted TEVAR for zone 0 acute type A dissection achieved high immediate technical success and acceptable complication rates with sustained branch patency over 5 years. These findings support the feasibility and safety of a standardized cerebral protection and device strategy, while prospective multicenter controlled studies are needed to confirm generalizability and comparative effectiveness.