Aortic Arch Repair Using Open and Hybrid Techniques: A Systematic Review

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Aortic arch aneurysms and dissections necessitate early surgical intervention.
• Optimal surgical management strategies and their comparative postoperative outcomes require further definition.

Purpose of the Study:

• To systematically review and compare postoperative outcomes of total arch replacement versus hybrid arch repair for aortic arch pathologies.
• To identify the optimal surgical approach based on available evidence.

Main Methods:

• Systematic review of retrospective cohort studies from the PubMed database (inception to June 2022).
• Inclusion of studies reporting on outcomes for total arch replacement and hybrid arch repair.
• Analysis of data from 12 identified studies involving 618 patients (hybrid repair) and 2,104 patients (total arch replacement).

Main Results:

• Similar rates of permanent neurologic dysfunction, acute kidney injury, and short-term mortality were observed between the two approaches.
• Hybrid arch repair was associated with higher postoperative reintervention rates.
• Conflicting data exist regarding midterm and long-term survival, and hospital/ICU length of stay.

Conclusions:

• Both total arch replacement and hybrid arch repair offer comparable short-term outcomes for aortic arch pathologies.
• Hybrid repair may necessitate increased reinterventions postoperatively.
• Further prospective studies are needed to clarify midterm and long-term survival differences and optimize surgical decision-making.