Dual- and Triple-Branched Endografts for Zone 0 Aortic Arch Reconstruction: A Narrative Review of Current Devices and Outcomes

Dedicated dual- and triple-branched endografts represent a transformative innovation for achieving secure Zone 0 proximal landing in aortic arch reconstruction. Driven by the limitations of traditional open and hybrid approaches, these dedicated devices integrate advanced design features—such as customizable dual-inner branch configurations, mechanical interlock systems, pre-curved ascending aortic stents, and ultra-low-profile delivery systems to enhance fixation, minimize wall stress, and reduce procedural complications. Early clinical experiences have shown promising outcomes with high freedom from aorta-related mortality and low rates of endoleaks and reinterventions, although challenges related to device durability, anatomical variability, and long-term patency remain. As the field shifts from physician-modified prototypes to dedicated commercial platforms, ongoing research is focused on refining device adaptability and integrating advanced imaging and computational modeling to further personalize treatment strategies. These trends underscore an industry-wide move toward minimally invasive, endovascular solutions that aim to improve patient outcomes in the management of complex aortic arch pathologies. Clinical Impact Dedicated dual- and triple-branched endografts enable fully endovascular Zone 0 repair, reducing the need for open or hybrid surgery. For clinicians, they broaden treatment options for high-risk patients and simplify procedural planning. As designs and imaging integration evolve, these devices are expected to improve durability, predictability, and long-term outcomes—marking a major step toward a truly minimally invasive standard for aortic arch reconstruction.