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Ann Cardiothorac Surg. 2018 May;7(3):372-379. doi: 10.21037/acs.2018.04.03.

Zone zero hybrid arch exclusion versus open total arch replacement.

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Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA.


Open total aortic arch replacement is one of the most technically demanding operations in cardiothoracic surgery, requiring operator expertise and intraoperative and postoperative teamwork. Despite current advancements in the field of open aortic surgery with regard to intraoperative brain protection and postoperative care, the morbidity and mortality associated with open total arch operations varies. Endovascular and hybrid procedures involving the use of zone 0 as a landing zone allow fair comparison between open total arch and hybrid operations. Hybrid procedures involving all of the other landing zones [1-4] should not be compared with open total arch replacement, as the extent of the pathology is different.


Aorta; endovascular procedures; stents; thoracic

Conflict of interest statement

Conflicts of Interest: Dr. O Preventza is a consultant for W.L. Gore and Associates, is a former Medtronic consultant, and participates in clinical studies for Medtronic, Gore, and Vascutek Terumo. Dr. JS Coselli is a consultant for Vascutek Terumo, Gore, and Medtronic; receives royalties from Vascutek Terumo; and participates in trials for Vascutek Terumo, Gore, Medtronic, Bolton Medical, Abbott, and Edwards Lifesciences. The other authors have no conflicts of interest to declare.

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