Hybrid cerebral perfusion in aortic arch surgery: Bridging antegrade and retrograde techniques

To evaluate the safety and effectiveness of hybrid cerebral perfusion in open total/partial arch replacement.

A retrospective analysis was performed of all adult patients (n = 366) undergoing open total/partial arch replacement from January 1993 through December 2024. Cerebral perfusion strategies included hybrid (retrograde followed by antegrade; n = 223, 60.9%), antegrade-only (n = 100, 27.4%), retrograde-only (n = 17, 5.0%), and deep hypothermic circulatory arrest alone without cerebral perfusion (n = 26, 7.1%). For comparison, patients were grouped as antegrade-only versus hybrid.

Over 30 years, total/partial arch replacement volume increased significantly (1993-2002: n = 16, 4.4%; 2003-2012: n = 90, 24.6%; 2013-2024: n = 260, 71.0%, P < .001), with most being reoperations (n = 202, 62.5%). Compared with antegrade-only, the hybrid group had a greater proportion of redo total/partial arch replacement (n = 149, 66.8% vs n = 53, 53.0%, P = .018) and frozen elephant trunk procedures (n = 109, 48.8% vs n = 20, 20.0%, P < .001) as well as longer cross-clamp and bypass times (both, P < .001). Although not statistically significant, stroke was nearly twice as frequent in the antegrade-only group (n = 6, 6.0% vs n = 8, 3.6%, P = .325). The operative mortality was greater in the antegrade-only group.

Hybrid cerebral perfusion in total/partial arch replacement demonstrates a strong safety profile with excellent early outcomes, including in complex or redo cases.