Clinical outcomes of hybrid surgery in the treatment of aortic arch disease: a retrospective study.

BACKGROUND: Hybrid aortic repair (HAR) has emerged as a less invasive alternative to conventional open arch repair for selected patients with aortic arch disease, but its comparative safety and mid-term effectiveness remain uncertain. This study aimed to compare the clinical outcomes of HAR and the frozen elephant trunk (FET) procedure for the treatment of aortic arch disease. METHODS: We conducted a retrospective analysis of 785 patients with aortic arch disease treated at Beijing Anzhen Hospital between January 2015 and February 2023. Among these patients, 406 underwent HAR, which consisted of supra-aortic debranching combined with thoracic endovascular aortic repair (TEVAR), and 379 received the FET procedure. Inverse probability of treatment weighting (IPTW) was used to eliminate baseline differences between the two groups, ensuring comparability of outcomes. The primary endpoints of the study were postoperative mortality, while the secondary endpoints included reintervention, perioperative stroke, paraplegia, and dialysis. RESULTS: Before IPTW adjustment, there was a significant difference in age between the two groups. Specifically, the patients in the HAR group were significantly older than those in the FET group [57.0 (49.0, 66.0) vs. 49.0 (40.0, 56.0) years, P<0.001]. The rates of diabetes (9.6% vs. 5.5%, P=0.045) and hyperlipidemia (21.7% vs. 9.0%, P<0.001) were also significantly higher in the HAR group than in the FET group. However, after adjusting for baseline differences using IPTW, none remained statistically significant. The pre-IPTW baseline data showed that, compared with the FET group, the HAR group had a significantly shorter operative time [5.5 (4.5, 6.5) vs. 6.5 (6.0, 7.0) minutes, P=0.02], lower blood loss [400.0 (150.0, 800.0) vs. 800.0 (600.0, 1,000.0) mL, P<0.001], and faster postoperative recovery [165.0 (75.0, 268.7) vs. 225.0 (145.0, 300.0) hours, P<0.001]. After IPTW adjustment, the HAR group continued to demonstrate significantly lower blood loss [500.0 (200.0, 900.0) vs. 800.0 (600.0, 1,000.0) mL, P=0.03]. No significant difference was observed between the two groups in terms of in-hospital mortality. The mid-term survival analysis revealed a higher mortality rate in the HAR group (8.6% vs. 3.9%, P=0.04); however, after IPTW adjustment, this difference was no longer statistically significant (P=0.18). CONCLUSIONS: This study found that, compared with the FET group, the HAR group demonstrated comparable postoperative mortality and reintervention rates, along with a shorter operative time, reduced blood loss, and a lower incidence of specific pulmonary complications, supporting its use in high-risk patients. However, HAR may increase the risk of neurological complications. Therefore, strict patient selection, careful anatomical assessment, and technical optimization are required to ensure long-term safety and efficacy.