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

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. [ABSTRACT FROM AUTHOR]