Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching.
OBJECTIVE
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.


METHODS
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).


RESULTS
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).


CONCLUSIONS
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.
['Hiraoka|Arudo|A|', 'Chikazawa|Genta|G|', 'Totsugawa|Toshinori|T|', 'Tamura|Kentaro|K|', 'Ishida|Atsuhisa|A|', 'Sakaguchi|Taichi|T|', 'Yoshitaka|Hidenori|H|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001013:Aorta, Thoracic D001018:Aortic Diseases D001807:Blood Vessel Prosthesis D019917:Blood Vessel Prosthesis Implantation D057510:Endovascular Procedures D005260:Female D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D011183:Postoperative Complications D057216:Propensity Score D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
aortic arch repair hybrid arch repair thoracic endovascular aortic repair propensity score matching