Comparison of Early and Intermediate-Term Outcomes Between Hybrid Arch Debranching and Total Arch Replacement: A Systematic Review and Meta-analysis of Propensity-Matched Studies

OBJECTIVESTo systematically review and pool the clinical outcomes of hybrid arch repair (HAR) and total arch replacement (TAR) with or without a frozen elephant trunk for treating aortic arch aneurysms, dissections, or other pathology in propensity score-matched studies. METHODSWe conducted electronic database searches in PubMed, Embase, the Cochrane Library, and Google Scholar to identify studies reporting outcomes of HAR versus TAR. Risk of bias was assessed using non-randomized studies of interventions (ROBINS-I) tool. The primary outcome was in-hospital mortality analyzed using a random-effects model to compute the odds ratio (OR). Survival probability was expressed as hazard ratios (HR) calculated through the inverse variance method. The results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTSThis meta-analysis included 13 studies with 3,392 patients. There was no significant difference in in-hospital mortality between HAR and TAR groups (OR 1.08; 95% CI 0.78-1.49; p = 0.630). However, HAR group showed a higher incidence of permanent neurological dysfunction (PND) (OR 1.71; 95% CI 1.22-2.41; p < 0.001). In subgroup meta-analysis with isolated type A aortic dissection (ITAAD), HAR showed significantly lower in-hospital mortality (p = 0.040) but no difference in PND. Other post-operative complications were significantly lower in the HAR group for renal failure (OR 0.65; 95% CI 0.49-0.87; p < 0.001), sternal re-entry due to bleeding (OR 0.55; 95% CI 0.34-0.89; p = 0.010), and tracheostomy (OR 0.61; 95% CI 0.38-0.96; p = 0.030). There is no statistical difference in 3-year survival probability (HR 0.97; 95% CI 0.70-1.35; p = 0.870). CONCLUSIONSTAR has more favorable than HAR in MDAD patients, offering lower rates of neurological dysfunction and better 3-year freedom from re-intervention. For ITAAD patients, HAR potentially provides better in-hospital mortality and 3-year survival rates, with fewer complications such as renal failure, re-sternotomy, and tracheostomy.