Hybrid versus open repair of aortic arch aneurysms: Comparison of postoperative and mid-term outcomes with a propensity score-matching analysis

Yoshiyuki Tokuda, Hideki Oshima, Yuji Narita, Tomonobu Abe, Yoshimori Araki, Masato Mutsuga, Kazuro Fujimoto, Sachie Terazawa, Kei Yagami, Hideki Ito, Kiyoto Yamamoto, Kimihiro Komori, Akihiko Usui

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)

Abstract

OBJECTIVES: 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.

Original languageEnglish
Pages (from-to)149-156
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume49
Issue number1
DOIs
Publication statusPublished - 01-2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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