Acute Aortic Dissection Surgery: Hybrid Debranching Versus Total Arch Replacement

Abstract

Objectives: It is unclear whether the hybrid debranching or total arch replacement (TAR) technique is preferential in treatment of acute Stanford type A aortic dissection (AAAD) among different age groups. The aim was to compare the clinical outcomes for the two therapeutic strategies.

Design: Retrospective.

Setting: University medical center, single institutional.

Participants: Four hundred thirty-seven registered patients with AAAD who underwent aortic surgery from 2017 to 2019 were included in the analysis, and 309 met eligibility criteria for the study. Those excluded had an aortic landing zone 1 to 4, concomitant valve or coronary operations, staged thoracic endovascular aortic repair after TAR, and organ ischemia including renal and neurologic dysfunction.

Interventions: Hybrid debranching or TAR surgery.

Measurements and main results: Perioperative and mid-term (2 years) follow-up data were analyzed to evaluate outcomes between the 2 interventions. In the hybrid versus TAR groups, findings included hospital length of stay (days) of 22.3 ± 2.0 v 28.6 ± 5.0 (p < 0.001) for those ≥60 years and 18.6 ± 1.8 v 19.5 ± 2.8 (p = 0.061) for those <60 years; postoperative neurologic events in 5.2% v 16.7% (p = 0.038) of those ≥60 years and in 5.1% v 4.7% (p = 0.752) of those <60 years; renal insufficiency in 5.2% v 23.8% (p = 0.003) of those ≥60 years and 2.6% v 10.2% (p = 0.243) of those <60 years; midterm survival in 95.1% v 65.2% (p = 0.037) of those ≥60 years and 100% v 100% (p > 0.999) of those <60 years; and a reintervention rate of 5.2% v 0% (p < 0.05) in those ≥60 years and 7.7% v 0% (p < 0.05) in those <60 years.

Conclusion: In the treatment of AAAD, patients older than 60 years undergoing hybrid debranching surgery had shorter hospital lengths of stay, lower rates of neurologic events and renal insufficiency, and a higher mid-term survival rate compared with the TAR procedure, whereas there was no statistical difference in hybrid debranching versus TAR in patients younger than age 60. Irrespective of reintervention, hybrid debranching can be a promising surgical option for patients with AAAD older than 60 years.

Keywords: aortic arch; hybrid debranching; total arch replacement; type A acute aortic dissection.