Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching.
The aim of this study is to evaluate the objective outcomes of conventional total aortic arch repair (CTAR) and hybrid arch repair by using propensity-score matching to reduce selection bias.



Between January 2006 and April 2016, 470 consecutive patients underwent isolated aortic arch repair (excluding hemiarch or partial arch reconstruction, and cases with concomitant cardiac surgeries) at a single cardiovascular institute. We categorized 337 total aortic arch repair with antegrade cerebral perfusion under circulatory arrest as the CTAR group and 58 hybrid aortic arch repair (HAR) with thoracic endovascular aortic repair as the HAR group. Seventy-five patients with scheduled and staged thoracic endovascular aortic repair after total aortic arch repair with elephant trunk were excluded. Then, we compared early and midterm outcomes between the propensity-matched group (43 CTAR vs HAR pairs).



There were no significant differences in 30-day and operative deaths between the CTAR and HAR groups (4.7% [2/43] vs 7.0% [3/43]; P = .4142 and 11.6% [5/43] vs 16.3% [7/43]; P = .5637). Although there were no significant differences in the incidences of other major complications, permanent stroke was observed more frequently in the HAR group (0% [0/43] vs 11.6% [5/43]; P = .0064) compared with the CTAR group. Matching analysis, however, revealed an equivalent 5-year survival rate between the CTAR and HAR groups (80.5% vs 59.9%; P = .1300).



Matching analysis revealed a significantly greater incidence of stroke in the HAR group but equivalent midterm outcomes in the hybrid group compared with the CTAR group.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan. Electronic address: bassbord1028@yahoo.co.jp.
Arudo
A
Hiraoka
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Genta
G
Chikazawa
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Toshinori
T
Totsugawa
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Kentaro
K
Tamura
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Atsuhisa
A
Ishida
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Taichi
T
Sakaguchi
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
Hidenori
H
Yoshitaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
aortic arch repair; hybrid arch repair; propensity score matching; thoracic endovascular aortic repair