Recurrent laryngeal nerve injury
Proponents of zone 0 aortic arch repair argue that the proximalisation
of the surgical field not only improves the surgeon’s access to the
sites of anastomosis but also decreases risk of damaging the recurrent
laryngeal nerve (RLN), which loops under the aortic arch in close
proximity to zones 2 and 3.18, 29 Indeed, Leoneet al. concluded that proximalisation of arch repair from zone 3
to zone 2 reduces the risk of RLN injury from 11% to 2.8%, while Jakob
and colleagues argue that Z-2-FET effectively eliminates this
risk.18, 23 It is therefore unsurprising that
following Z-0-FET, Yamamoto et al. reported only a single
incidence of vocal cord paralysis resulting from RLN
injury.16 In contrast, Beckmann noted a 18% (n=17)
incidence of RLN palsy following Z-2-FET.12 Indeed,
reduced incidence of RLN palsy may well represent surgical advancement
with FET proximalisation.