CONCLUSION
The advantages of FET procedures over cET procedures, and that of
Z-2-FET over Z-3-FET are widely reported and
well-documented.1, 5 It is clear that Z-2-FET
currently represents an efficacious, robust approach to treating Type A
AAD and other structural aortic arch pathologies. Indeed, recent data
from novel trials investigating Z-0-FET are promising and seem to
suggest that proximalisation of the distal anastomosis not only improves
surgical access (thereby shortening CPB, ACP, and HCA time) but also is
associated with improved mortality rates and lower incidence of SCI,
cerebral injury, RLN injury, renal injury, and visceral
ischaemia.16, 17, 18 This said, it should be recalled
that efficacy of Z-0-FET in terms of FL obliteration and postoperative
TL integrity is varied.16 Therefore, larger scale
investigations comparing both approaches and their respective techniques
and complications would shed light and help determine whether
proximalisation of aortic repair from Zone 2 to Zone 0 is simply
concept, or a true challenge that represents the next step forward in
aortic repair.