Mortality
In-hospital and 30-day mortality are key considerations surrounding any form of surgery – but are particularly relevant in such a high-risk, complex procedure as aortic arch replacement. Interestingly, findings from Yamamoto et al. and Jakob et al. regarding mortality following Z-0-FET seem to suggest proximalisation of aortic arch repair does indeed represent advancement, especially when compared to results on postoperative mortality from Leone et al. , Tsagakis et al., Jakob et al. , and Beckmann et al. Yamamoto and colleagues report a 6.5% (n=7) rate of in-hospital mortality, attributable to multisystem failure (n=3), heart failure (n=1), exacerbation of pre-existing cerebral infarct (n=1), pneumonia (n=1), and left ventricular rupture (n=1).16 Jakob et al. reported a single in-hospital mortality (their only mortality to date) attributable to right heart failure following Z-0-FET.17 In contrast, Z-2-FET seems to be associated with in-hospital mortality rates between 11% and 20%, attributable to factors including cardiogenic shock, heart failure, aortic rupture, pulmonary failure, pulmonary embolism, and ischaemic cerebrovascular accident.11-13, 22, 23 A similar trend is observed in 30-day mortality rates: while Yamamoto et al. reports a 1.8% rate of 30-day mortality and Jakob et al. notes that the 5 surviving patients reviewed survived for between 4 to 38 months post-Z-0-FET repair, Tsagakis et al. , Beckmann et al. and Jakob et al. note 30-day mortality rates of 11%, 8%, and 10% respectively.11-13, 16, 23 At this stage, because the Z-0-FET approach is still relatively novel, it is unclear whether this discrepancy is due to the Z-0-FET approach being truly superior to Z-2-FET repair. Yet, it is worth noting that at baseline, the patients included in the above-mentioned trials are relatively heterogenous and similar to one another both clinically and aetiologically.