Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis.
OBJECTIVE
Operative strategies for repairing aortic arch aneurysms should be re-evaluated following recent technical advances.


METHODS
Of 364 patients who underwent aortic arch repair between 2002 and 2014, 58 were high-risk subjects who received isolated hybrid arch repair (HAR) via median sternotomy (type I n = 32, type II n = 1 and type III n = 25). During this period, excluding patients with type A dissection or extensive aneurysms, 124 patients received isolated open arch repair via median sternotomy. The patients in the HAR and open arch repair groups were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors.


RESULTS
The patients in the HAR group were older (77 years ± 6 vs 69 ± 9, P < 0.0001), exhibited a greater rate of malignancy (21 vs 4.8%, P = 0.0022) and had higher logistic EuroSCORE values (31 ± 18 vs 20 ± 15, P < 0.0001) than those in the open arch repair group. Following propensity score matching creating 38 matched pairs, the differences in preoperative risk diminished. Operative complications, including the mortality rate (2.6 vs 0%), were similar between the groups. Apart from the lower rates of cardiopulmonary bypass (CPB) and circulatory arrest, there was no apparent superiority of HAR with respect to patient recovery. The mean follow-up duration was 52.5 months, during which the rate of freedom from aortic events in the HAR and open arch repair groups was 79 and 99% at 24 months, respectively (P < 0.0001).


CONCLUSIONS
HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan tokuda@mxb.mesh.ne.jp.
Yoshiyuki
Y
Tokuda
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hideki
H
Oshima
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yuji
Y
Narita
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Tomonobu
T
Abe
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yoshimori
Y
Araki
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Masato
M
Mutsuga
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kazuro
K
Fujimoto
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Sachie
S
Terazawa
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kei
K
Yagami
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hideki
H
Ito
Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kiyoto
K
Yamamoto
Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kimihiro
K
Komori
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Akihiko
A
Usui
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D057216:Propensity Score; D012189:Retrospective Studies; D056346:Sternotomy / Q000401:mortality; D016896:Treatment Outcome
Aortic arch aneurysm; Hybrid arch repair; Thoracic endovascular aortic repair