Hybrid Aortic Surgery: Clinical Outcomes and Techniques in Complex Aortic Pathologies

This study aimed to evaluate the clinical outcomes of hybrid aortic surgery in patients with complex aortic pathologies, with a focus on technical success, postoperative morbidity, and mortality.

A retrospective observational study was conducted on 24 patients who underwent hybrid aortic surgery between 2019 and 2024. Four surgical approaches were categorized on the basis of the pathological location: (1) median sternotomy with bypass from the ascending aorta to the branches of the aortic arch, followed by thoracic endovascular aortic repair (TEVAR); (2) cervical incision with left carotid-to-subclavian bypass, right carotid-to-left carotid bypass, or right carotid-to-left subclavian bypass and TEVAR; (3) median laparotomy with bypass from the iliac arteries to the superior mesenteric artery, renal arteries, and celiac trunk followed by endovascular aortic repair (EVAR); and (4) femoral incision with crossover bypass and EVAR. Data on demographics, preoperative diagnoses, surgical techniques, and postoperative outcomes were collected.

No significant differences in demographic characteristics or comorbidities were found between the surgical groups. However, a significant association was observed between the location of the aortic pathology and the chosen surgical approach (p=0.019). Patients who underwent the femoral incision approach had a shorter hospital stay than those who did not (p=0.075). Postoperative complications were generally low across all groups; however, infection rates were higher at specific anatomical sites, such as the femoral incision area (p=0.002). No significant differences between the groups were observed in hospital or early mortality rates.

Hybrid aortic surgery is a safe and effective approach for treating complex aortic pathologies, particularly when traditional open or endovascular procedures are individually insufficient. Minimally invasive techniques, such as femoral incisions, offer advantages in reducing recovery time but may be associated with higher infection rates in isolated anatomical sites. However, these benefits are questioned, and further studies with larger populations are needed to validate these findings.