Hybrid technique and total arch replacement combined with frozen elephant trunk in acute aortic dissection involving the aortic arch: a multi-center propensity-matched cohort study.

Background: The aim of this study was to investigate whether the hybrid technique yields superior outcomes in comparison with the total arch replacement combined with frozen elephant trunk (TAR + FET) for acute aortic dissection (AAD) involving the aortic arch.

Methods: This retrospective cohort study using propensity-score matching included patients with AAD involving the aortic arch admitted to Nanjing First Hospital and Shanghai General Hospital from January 2015 to June 2020. The in-hospital and mid-term outcomes were compared between patients who received hybrid treatment (n = 136) and those who received TAR + FET (n = 415). Study end points included in-hospital mortality and morbidity, and mid-term rates of death from all causes, stroke, and aortic re-intervention.

Results: A total of 121 pairs were formed after matching. In-hospital mortality did not differ between hybrid versus TAR + FET groups (5.8% vs. 7.9%, P = .860). Up to 6 years, patients treated with TAR + FET were associated with reduced rate of aortic re-intervention (HR 0.21, 95% CI 0.05-0.97; P = .023). There was no difference in death from all causes and stroke.

Conclusions: Hybrid technique and TAR + FET showed comparable mid-term survival. Hybrid technique showed higher rate of aortic re-intervention and should therefore be applied with great caution in patients with AAD involving the aortic arch.