Early-to-midterm outcomes of aortic balloon occlusion technique versus hybrid procedure for aortic arch diseases.

Abstract

The goal of this study was to compare the early-to-midterm outcomes of patients treated with the frozen elephant trunk procedure with aortic balloon occlusion (FET-ABO) versus hybrid repair for aortic arch diseases. Patients who underwent the FET-ABO (n = 134) and the hybrid procedure (n = 220) from 2017 to 2020 at our institution were analysed retrospectively. Early-to-midterm outcomes were compared using inverse probability weighting. Low-risk and high-risk subgroup analyses were performed according to the cut-off of the additive European System for Cardiac Operative Evaluation value of 6. The present study demonstrated similar 30-day mortality (3.7% vs 8.6%; P = 0.118) and adverse events between the FET-ABO and the hybrid groups. Fewer intraoperative red blood cell transfusions (0.54 ± 1.45 vs 1.26 ± 2.47 U; P = 0.001), decreased total hospital costs (P < 0.001) and considerable early-to-midterm survival [crude: hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.17-0.91; P = 0.030; adjusted: HR 0.35, 95% CI 0.13-0.91; P = 0.032) were obtained with the FET-ABO compared to the hybrid procedure. The inverse probability weighting method substantiated the foregoing results. Adjusted subgroup analyses suggested that the FET-ABO procedure had a trend towards improved survival in low-risk patients (HR 0.17, 95% CI 0.03-0.93; P = 0.041) and achieved outcomes comparable to those of the hybrid procedure in high-risk patients (HR 0.46, 95% CI 0.15-1.42; P = 0.176). The FET-ABO technique could be better promoted in hospitals lacking experience and equipment and could be more viable and cost-effective for selected patients compared with the hybrid procedure.