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Aortic proximalization-Zone 0 versus Zone 2: A concept or true challenge?

Sven Z C P Tan¹, Aleksandra Lopuszko¹, Wahaj Munir¹

¹Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Journal of Cardiac Surgery

|June 10, 2021

Summary

Proximalizing Frozen Elephant Trunk (FET) repair to Zone 0 (Z-0-FET) may offer a more accessible surgical approach and fewer complications compared to Zone 2 (Z-2-FET). However, further prospective research is needed to confirm these benefits for aortic arch pathologies.

Keywords:

Zone 0 Zone 2 aortic arch aortic dissection arch repair frozen elephant trunk

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Aortic Surgery

Background:

The Frozen Elephant Trunk (FET) technique is increasingly used for complex aortic pathologies.
Surgical preference has shifted from Zone 3 (Z-3-FET) to Zone 2 (Z-2-FET) for improved outcomes.
This review examines the potential benefits of proximalizing FET repair to Zone 0 (Z-0-FET).

Purpose of the Study:

To compare the efficacy of Zone 2 Frozen Elephant Trunk (Z-2-FET) versus Zone 0 Frozen Elephant Trunk (Z-0-FET) procedures.
To evaluate differences in surgical technique, clinical outcomes, and adverse event rates.
To determine if proximalization of arch repair to Zone 0 offers advantages over Zone 2.

Main Methods:

Literature review of comparative studies.
Evaluation of surgical technique, clinical outcomes, and adverse events.
Analysis of data comparing Z-2-FET and Z-0-FET.

Main Results:

Zone 0 Frozen Elephant Trunk (Z-0-FET) appears to offer a more accessible surgical approach with shorter procedural durations.
Z-0-FET may be associated with lower rates of neurological, renal, and recurrent laryngeal nerve injury, as well as reduced mortality and reintervention.
However, Z-0-FET presents challenges, and its efficacy in true lumen integrity and false lumen thrombosis is variable.

Conclusions:

Current retrospective data suggest Z-0-FET procedures are simpler and linked to fewer adverse events than Z-2-FET.
The majority of evidence is retrospective, necessitating further investigation.
Prospective research is recommended to definitively assess the comparative advantages of Z-0-FET over Z-2-FET for aortic arch pathologies.