The outcomes of aortic arch repair between open surgical repair and debranching endovascular hybrid surgical repair: A systematic review and meta-analysis

Background: At present, open surgical aortic arch repair (OAR) and debranching hybrid surgical aortic arch repair (HAR) serve as significant fi cant therapeutic approaches for aortic arch aneurysm or dissection. It remains unclear which technique is preferable. Our study aimed to compare the short-term and long-term outcomes of these two procedures. Methods: To identify comparison studies of debranching HAR and OAR, a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was performed from January 2002 to April 2022. This study was registered on PROSPERO (CRD42020218080). Results: Sixteen publications (1316 patients), including six propensity score-matching (PSM) analysis papers, were included in this study. Compared with the HAR group, the patients who underwent OAR were younger (OAR vs HAR: 67.53 +/- 12.81 vs 71.29 +/- 11.0; P < . 00001), had less coronary artery disease (OAR vs HAR: 22.45% vs 32.6%; P = . 007), less chronic obstructive pulmonary disease (OAR vs HAR: 16.16% vs 23.92%; P = . 001), lower rates of previous stroke (OAR vs HAR: 12.46% vs 18.02%; P = . 05), and a lower EuroSCORE (European System for Cardiac Operative Risk Evaluation) score (OAR vs HAR: 6.27 +/- 1.04 vs 6.9 +/- 3.76; P < . 00001). HAR was associated with less postoperative blood transfusion (OAR vs HAR: 12.23% vs 7.91%; P = . 04), shorter length of intensive care unit stays (OAR vs HAR: 5.92 +/- 7.58 days vs 4.02 +/- 6.60 days; P < . 00001) and hospital stays (OAR vs HAR: 21.59 +/- 17.54 days vs 16.49 +/- 18.45 days; P < . 0001), lower incidence of reoperation for bleeding complications (OAR vs HAR: 8.07% vs 3.96%; P = . 01), fewer postoperative pulmonary complication (OAR vs HAR: 14.75% vs 5.02%; P < . 0001), and acute renal failure (OAR vs HAR: 7.54% vs 5.17%; P = . 03). In the PSM subgroup, the rates of spinal cord ischemic (OAR vs HAR: 5.75% vs 11.49%; P = . 02), stroke (OAR vs HAR: 5.1% vs 17.35%; P = . 01), and permanent paraplegia (OAR vs HAR: 2.79% vs 6.08%; P = . 006) were lower in the OAR group than that in the HAR group. Although there was no statistically significant fi cant difference in 1-year survival rates (HAR vs OAR: hazard ratio [HR]: 1.54; P = . 10), the 3-year and 5-year survivals were significantly fi cantly higher in the OAR group than that in the HAR group (HAR vs OAR: HR: 1.69; P = . 01; HAR vs OAR: HR: 1.68; P = . 01). In the PSM subgroup, the OAR group was also significantly fi cantly superior to the HAR group in terms of 3-year and 5-year survivals (HAR vs OAR: HR: 1.73; P = . 04; HAR vs OAR: HR: 1.67; P = . 04). The reintervention rate in the HAR group was significantly fi cantly higher than that in the OAR group (OAR vs HAR: 8.24% vs 16.01%; P = . 01). The most common reintervention was postoperative bleeding (8.07%) in the OAR group and endoleak (9.67%) in the HAR group. Conclusions: Our meta-analysis revealed that debranching HAR was associated with fewer perioperative complications than the OAR group, except for postoperative permanent paraplegia, reintervention, and stroke events. The OAR group demonstrated better 3-year and 5-year survivals than the debranching HAR group. However, patients in the OAR group had fewer comorbid factors and were younger than those in the HAR group. High-quality studies and well-powered randomized trials are needed to further evaluate this evolving fi eld. (J Vasc Surg 2024;79:1510-24.)