Comparison of open and hybrid endovascular repair for aortic arch: a multi-centre study of 1052 adult patients

Abstract

Objectives: We aimed to evaluate early and late outcomes by comparing open total arch repair and endovascular arch repair using proximal landing zone analysis in a multicentre cohort.

Methods: From 2008 to 2019, patients treated surgically for aortic arch disease at 6 centres were included, excluding cases with type A aortic dissection, additional aortic root replacement and extensive aortic aneurysm. In all patients and populations with proximal landing zones 0/1 (N = 144) and 2 (N = 187), early and late outcomes were compared using propensity score matching.

Results: A total of 1052 patients, including 331 (31%) and 721 (69%) patients undergoing endovascular arch repair and open total arch repair, respectively, were enrolled. After propensity score match (endovascular arch repair, 295; open total arch repair, 566), no significant difference was observed in in-hospital mortality rate (endovascular arch repair, 6.8%; open total arch repair, 6.2%; P = 0.716). Open total arch repair was associated with a lower risk of all-cause death [log-rank test; P = 0.010, hazard ratio (HR) 1.41 (95% confidence interval 1.17-1.71)]. The incidence of aorta-related death was higher in endovascular arch repair [Gray's test; P = 0.030, HR; 1.44 (95% confidence interval 1.20-1.73)]. When compared to endovascular arch repair with proximal landing zone 0/1, open total arch repair was associated with lower risks of all-cause death [log-rank test; P < 0.001, HR 2.04 (95% confidence interval 1.43-2.90)] and aorta-related death [Gray's test; P = 0.002, HR 1.67 (95% confidence interval; 1.25-2.24)]. There was no difference in the risk of all-cause death [log-rank test; P = 0.961, HR 0.99 (95% confidence interval 0.67-1.46)] and aorta-related death [Gray's test; P = 0.55, HR 1.31 (95% confidence interval 1.03-1.67)] between endovascular arch repair with proximal landing zone 2 and open total arch repair.

Conclusions: Open total arch repair was considered the 1st choice based on early and late results; however, endovascular arch repair may be a useful option if the proximal landing zone is limited to zone 2.

Keywords: Aortic arch disease; Endovascular arch repair; Hybrid arch repair; Thoracic endovascular aortic repair; Total arch repair.