title: Aortic arch aneurysm: short- and mid-term results comparing open arch surgery and the hybrid procedure†.
abstract: OBJECTIVE
  Open arch surgery for aortic arch aneurysm was historically associated with a high risk of postoperative morbi-mortality. Improved operative techniques have now lowered the incidence of these complications but in parallel, hybrid arch procedures have emerged. Nowadays, very little data are available about their mid-term results compared with open surgery.
  
  
  METHODS
  From January 2002 to January 2014, 46 patients had treatment for an exclusive aortic arch aneurysm including 25 open arch surgeries and 21 type I hybrid arch procedures in our institution. All cases involved arch aneurysms involving at least one carotid artery (Zone 0 and Zone 1). Aneurysms of the distal arch and descending aorta were excluded (Zone 2 and beyond). Results from a retrospective database are reported. There were no patients lost to the follow-up.
  
  
  RESULTS
  There was no significant difference in preoperative comorbidities between the two groups. The incidence of in-hospital mortality was similar at 20% (5/25) for open surgery and 19% (4/21) for hybrid procedure (P = 0.830). The incidence of permanent cerebral neurological deficit was comparable at 17.4% (4/23) for open surgery and 21.1% (4/19) for hybrid procedure (P = 1). Median survival was 109.5 months for open surgery and 56.3 months for hybrid procedure. Freedom from all-cause mortality was 78, 63, 63 and 57% at 1, 3, 5 and 7 years, respectively in the open surgical group. Freedom from all-cause mortality was 74, 55, 46 and 28% at 1, 3, 5 and 7 years, respectively in the hybrid group. Survival rates and incidence of major adverse cardiac and cerebro-vascular event between open surgery and hybrid procedure were not statistically different (P = 0.530 and P = 0.325, respectively). However, incidence of reintervention was in favour of open surgery [14.5 vs 44.8% at 7 years, P = 0.045; 95% confidence interval: (0.06-0.97)].
  
  
  CONCLUSIONS
  The type I hybrid arch procedure fails to demonstrate better results compared with open surgery, regarding morbi-mortality at the short- and mid-term follow-up. Moreover, it increases the risk of reintervention. Patients treated by this technique must undergo a closer follow-up because of this risk. Larger randomized studies are needed to better define the exact indications of this therapy.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Toulouse, Toulouse, France cazavet.a@free.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cazavet
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Alacoque
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Toulouse, Toulouse, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.affiliation: Department of Vascular Surgery, University Hospital of Toulouse, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Chaufour
authors.affiliation: Department of Interventional Radiology, University Hospital of Toulouse, Toulouse, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Rousseau
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Toulouse, Toulouse, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Glock
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Toulouse, Toulouse, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Leobon
mesh_terms: D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Aortic arch; Endovascular procedure; Hybrid procedure; Surgical procedure; Thoracic aortic aneurysm