Conventional Open Versus Hybrid Arch Repair of Aortic Arch Disease: Early and Long-Term Outcomes

Abstract

BACKGROUND: It is unclear at present whether conventional open repair or a hybrid technique is preferential in the treatment of aortic arch diseases. Our intent was to compare early and long-term outcomes of both therapeutic strategies.

METHODS: Between January 2002 and December 2017, 238 patients eligible for total arch replacement (TAR; 174) or hybrid arch repair (HAR; 64) qualified for study. A retrospective analysis of clinical outcomes was undertaken, with propensity matching (48 pairs). Mean follow-up duration was 60.2 months.

RESULTS: In-hospital mortality rates were 4.6% (8 of 174 patients) and 6.3% (4 of 64 patients) in the TAR and HAR groups, respectively (p = 0.739). The TAR group displayed a lower incidence of permanent stroke (2.9%, 5 of 174 patients) by comparison (HAR: 12.5%, 8 of 64 patients; p = 0.004). Overall survival rates at 5 and 10 years differed significantly by group (TAR: 87.0% ± 5.5% and 81.9% ± 4.8%, respectively; HAR: 69.5% ± 7.4% and 40.8% ± 11.1%, respectively; p = 0.003). After propensity matching, in-hospital mortality (4.2% versus 4.2%, p > 0.99) and patient morbidities showed no statistically significant group differences. For patients undergoing HAR, a tendency for permanent stroke (14.5% versus 2.1%, p = 0.070) was evident. In the TAR (versus HAR) group, 10-year overall survival (74.7% versus 42.6%, p = 0.043) and reintervention-free (93.2% versus 34.0%, p < 0.001) rates were significantly better.

CONCLUSIONS: In the treatment of aortic arch diseases, HAR showed equivalent short-term outcomes compared with TAR but was limited regarding long-term outcomes beyond 5 years after the procedure. Conventional TAR remains the gold standard of therapy, and our findings suggest that the hybrid approach should be reserved for strictly selected patients with significant comorbidities.