IMPACT FOR FUTURE RESEARCH
Though comparing the techniques and outcomes associated with Z-2-FET and Z-0-FET is vital to assess the extent to which proximalisation of arch repair represents therapeutic advancement, it should be stressed that the comparisons made herein are limited in a number of aspects. Perhaps most significantly is the fact that, relative to Z-2-FET and even Z-3-FET, Z-0-FET arch repair procedures are far more novel and are reported far less in literature. As a result, conducting statistical comparisons between the different procedures, perhaps via a meta-analysis of clinical outcomes, would be extremely challenging. Much of the literature on FET arch repairs are limited in value due to their notably small sample size and are largely retrospective cohort studies or individual case reports.16-18 Furthermore, FET arch repair procedures are particularly complex and exact surgical technique necessarily varies from patient-to-patient due to variations in anatomy, presentation, and disease progression.5 This represents an additional limitation to direct, retrospective, smaller-scale comparisons between Z-2-FET and Z-0-FET approaches. Larger scale, multi-centre, cohort studies or randomised trials including long-term follow up and monitoring would serve to elucidate better the true extent to which proximalisation of arch repair improves clinical outcomes.