How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis

• Published in: European journal of cardio-thoracic surgery 2014-07, Vol.46 (1), p.32-39
• Main Authors: Iba, Yutaka, Minatoya, Kenji, Matsuda, Hitoshi, Sasaki, Hiroaki, Tanaka, Hiroshi, Oda, Tatsuya, Kobayashi, Junjiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - methods; Female; Follow-Up Studies; Humans; Intensive Care Units; Length of Stay - statistics & numerical data; Male; Middle Aged; Perfusion - methods; Postoperative Complications; Propensity Score; Stents
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezt615

OBJECTIVES Recent advances in endovascular aortic repair have changed the treatment of aortic arch aneurysms. The purpose of this study was to compare the early and mid-term outcomes of open repair and hybrid arch repair for aortic arch aneurysms. METHODS This study included 143 and 50 patients who underwent open aortic repair and hybrid thoracic endovascular aortic repair (TEVAR), respectively, for non-dissecting aortic arch aneurysms from 2008 to 2013. The European System for Cardiac Operative Risk Evaluation II scores were 4.35 ± 3.65% and 7.78 ± 5.49% for the open and hybrid TEVAR groups, respectively (P < 0.001). Furthermore, 35 patients from each group were matched using propensity scores to adjust for differences in patient characteristics. RESULTS There was no significant difference in early mortality between the open and hybrid groups (3 vs 2%, P = 0.76). Early morbidity was equivalent in both groups, but intensive care unit (ICU) lengths of stay were shorter in members of the hybrid group (4.7 vs 1.6 days, P = 0.018). During the follow-up, survival rates were not significantly different (87 vs 81% at 3 years, P = 0.13), but reinterventions for the aortic arch were required in 1 patient (pseudoaneurysm) in the open group and 5 (endoleak in 4, brachiocephalic artery stenosis in 1) in the hybrid group. The rates of freedom from reintervention at 3 years were 99% in the open group and 80% in the hybrid group (P < 0.001). Propensity score matching yielded similar results for shorter ICU and hospital lengths of stay and more frequent reintervention in the hybrid group. CONCLUSIONS Surgical outcomes in both groups were satisfactory. Hybrid TEVAR was superior in terms of early recovery from surgery; however, open arch repair showed more reliable long-term outcomes. When properly selected according to patient risk, these two strategies improve the surgical results in all patients with aortic arch aneurysms.