Zone Zero Thoracic Endovascular Aortic Repair: A Proposed Modification to the Classification of Landing Zones

The authors present their experience in treating 39 patients with thoracic aortic endovascular repair of the ascending aorta who were determined to be very high risk for open surgical repair from 2006 to 2016.   Treated pathologies included acute type A dissection in 31%, intramural hematoma in 5%, pseudoaneurysm in 56%, and chronic dissection suture line entry tear in 8%.  Ascending TEVAR was performed in 36 pateints, and occluder devices were deployed in three patients with pseudoaneurysm. Operative mortality was 13% in this high risk group of patients, with complications including stroke in 10% and myocardial infarction in 5%.   The authors propose a zone zero classification system for describing the location of pathology by segmental proximity to the aortic annulus and for assessing prognosis.