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Updated: Feb 6, 2026

Visualization and Analysis of Pharyngeal Arch Arteries using Whole-mount Immunohistochemistry and 3D Reconstruction
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Zone zero hybrid arch exclusion versus open total arch replacement.

Ourania Preventza1,2, Corinne W Tan2, Vicente Orozco-Sevilla2

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Open total aortic arch replacement is complex, with variable outcomes despite advancements. Hybrid procedures using zone 0 are comparable, but other hybrid zones are not due to differing pathology extent.

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Area of Science:

  • Cardiothoracic Surgery
  • Vascular Surgery
  • Aortic Surgery

Background:

  • Open total aortic arch replacement is a highly complex cardiothoracic procedure.
  • Outcomes for open total aortic arch replacement vary despite improvements in brain protection and postoperative care.
  • Standardized comparisons between open and hybrid aortic arch procedures are challenging.

Purpose of the Study:

  • To clarify the comparability of open total aortic arch replacement with hybrid procedures.
  • To define appropriate comparisons based on landing zones and pathology extent.

Main Methods:

  • Comparative analysis of open total aortic arch replacement and hybrid aortic procedures.
  • Evaluation of different landing zones (zone 0 vs. zones 1-4) in hybrid approaches.
  • Assessment of pathology extent in relation to surgical approach.

Main Results:

  • Hybrid procedures using zone 0 as a landing zone allow for a fair comparison with open total aortic arch replacement.
  • Hybrid procedures utilizing landing zones 1-4 involve different extents of pathology and are not directly comparable to open total aortic arch replacement.
  • The technical demands and outcomes of open total aortic arch replacement necessitate careful consideration of patient selection and procedural comparison.

Conclusions:

  • Comparisons between open total aortic arch replacement and hybrid procedures should be restricted to those using zone 0.
  • Hybrid procedures with landing zones 1-4 represent different pathologies and should not be equated with open total aortic arch replacement.
  • Accurate comparison requires matching the extent of aortic disease treated by each surgical approach.