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.