Conventional open versus hybrid aortic arch repair: a meta-analysis of propensity-matched studies.

Abstract

BackgroundComparison of conventional (open) surgical versus hybrid aortic arch repair remains debatable. While the majority of previous comparative studies including meta-analyses contained primarily risk-unadjusted cohorts, those focusing on propensity-matched comparisons were limited by their small sample size. We aimed to compare outcomes of these two approaches through an up-to-date search and meta-analysis of the best evidence currently available in the literature.MethodsThe PubMed/MEDLINE, EMBASE, and Cochrane library from inception to September 2019 were searched to identify articles reporting propensity-score matching data on open versus hybrid aortic arch repair. Patients’ baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Heterogeneity and biases were assessed among the included studies.ResultsFive studies, including a total of 378 patients (189 pairs), were included in the study. The two groups were similar in patients’ baseline characteristics. Stroke rate favoured the open group [2.1% versus 14.3%, OR 0.18 (0.07, 0.46), P=0.0004, I2=0%]. There was no significant difference between the two groups with regard to paraplegia. The hybrid group had numerically higher short-term mortality, but lower rate of acute renal failure requiring dialysis. There was a statistically significant difference between the mid-term survivals of the open and hybrid groups, with lower pooled mortality seen for the open group at 1-year and 2-years (P=0.02).ConclusionsOpen and hybrid repairs do not offer equivalent outcomes. Compared with hybrid aortic arch repair, conventional surgical aortic repair could be associated with favourable outcomes including postoperative stroke. Hybrid repair does not appear to provide better survival. Operative approaches should be carefully selected in treating aortic arch pathology.