Early outcomes of endovascular repair of aortic arch lesions in zone 0/1 with a thoracic branched endoprosthesis

Objective: The pivotal trial 30-day outcomes of the GORE TAG Thoracic Branch Endoprosthesis in patients with endovascular repair of the aortic arch or descending thoracic aorta using a zone 0 or 1 landing zone were evaluated. Methods: In this nonrandomized, multicenter, prospective study, the primary, clinically driven outcome was a composite of the following through 1 month: technical success (successful device deployment with maintenance of side-branch patency and the absence of aortic rupture), lesion-related mortality, disabling stroke, permanent paraplegia or paraparesis, new onset renal failure requiring permanent dialysis, and protocol-defined unanticipated reintervention. Results: The 77 study patients enrolled had aneurysm (n = 50), dissection (n = 24), or other isolated lesion types (n = 3); 90.9% of cases used a zone 0 proximal landing zone. Patients had a mean age of 70.8 ± 10.8 years; 66.2% were male and 57.1% White. All patients had both the aortic and side branch (SB) components implanted; 53 (68.8%) had a GORE TAG Conformable Thoracic Stent Graft distal extension, 20 (26.0%) required more than one device, and 6 (7.8%) had a proximal aortic extender. A single GORE TAG Thoracic Branch Endoprosthesis SB was implanted in 55 patients (71.4%), and 22 (28.6%) required more than one SB device. Technical success was achieved in 73 of 77 patients (94.8%); access site complications occurred in 4 patients. Of the patients with imaging, 77.8% (56 of 72) had successful aneurysm or primary entry tear exclusion (dependent on treated pathology) and were free from clinically evident stroke or other adverse outcomes at 30 days. In 16 of 72 patients, protocol-defined major adverse events included 3 (3.9%) lesion-related deaths, 6 (7.8%) strokes (1 died and 5 were with neurologic sequelae persistent at the 30-day cutoff), 4 (5.2%) unplanned additional procedure, and 1 renal failure. Four (6.0%) patients had type I or type III endoleak. There were no aortic ruptures or permanent paraplegia or paraparesis. Conclusions: This early experience pivotal trial demonstrates that repair of aortic arch pathology using a single SB endograft requiring proximal zone 0/1 placement had excellent treatment success and an acceptable level of perioperative complications in a cohort of patients deemed to be at high risk of open repair. Stroke and access site complications were the most frequent serious events and occurred more frequently in the aneurysm cohort. These initial data suggest that endovascular treatment of the arch is a suitable treatment option in appropriate patients. Longer-term follow-up will be required to establish how these results compare with open repair among similar patients.