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Isolated Endovascular Repair of the Ascending Aorta: Early Outcomes and Temporal Trends from a National Multicenter
Aidin Baghbani1, Gabriel Dominguez1, Akiko Tanaka1
1Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX.
Background:
Endovascular repair of the ascending aorta has emerged as a minimally invasive alternative for high-risk patients with zone 0 aortic pathology who are unsuitable for conventional open repair. This study evaluated perioperative outcomes, midterm durability, and temporal era effects associated with ascending thoracic endovascular aortic repair (TEVAR) using the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) database.
Methods:
The SVS-VQI TEVAR registry was queried through April 2026 to identify patients undergoing endovascular repair confined to zone 0. Procedures were performed across 28 participating VQI centers by 36 operators. Patients with proximal or distal landing zones extending beyond zone 0 were excluded. Baseline characteristics, procedural variables, perioperative outcomes, and midterm survival were analyzed. Kaplan-Meier analysis was used to estimate overall survival and freedom from stroke, endoleak, and aortic reintervention. Temporal era effects were evaluated by comparing early and contemporary procedural cohorts.
Results:
A total of 55 patients underwent ascending TEVAR confined to zone 0. The median age was 75 years, and most patients had significant cardiovascular comorbidity. Overall technical success was achieved in 52 patients (94.5%). The median operative duration was 110 minutes, and the median hospital stay was 4 days. Perioperative mortality was 14.5%, whereas stroke occurred in 1.8% of patients. Freedom from stroke was 97.5% at both 1 and 3 years. Freedom from aortic reintervention was 91.5% at 1 year and 83.2% at 3 years. Perioperative mortality decreased significantly from 25.9% in the early cohort to 3.6% in the contemporary cohort (P = 0.025), suggesting improved outcomes with increasing procedural experience.
Conclusion:
Ascending TEVAR confined to zone 0 is feasible with acceptable perioperative outcomes, low stroke and endoleak rates, and favorable midterm durability in selected high-risk patients. Significant improvement in outcomes over time highlights the importance of institutional experience and multidisciplinary expertise.
