• Liang Zhang, Cuntao Yu, Xiubin Yang, Xiaogang Sun, Juntao Qiu, Wenxiang Jiang, and Wang De The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, .
• Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
• J. Thorac. Cardiovasc. Surg. 2019 Nov 1; 158 (5): 1285-1292.

ObjectiveThe study objective was to determine whether hybrid aortic repair yields superior outcomes compared with the conventional surgical approach for DeBakey type I aortic dissection.MethodsA retrospective analysis of patients with DeBakey type I dissection admitted to Fuwai Hospital between January 2010 and December 2016 showed that 815 patients (86.9%) underwent open total arch replacement with frozen elephant trunk (frozen elephant trunk group) and 122 (13.1%) underwent hybrid aortic arch repair without deep hypothermic circulatory arrest (hybrid group). We selected 109 pairs of patients for propensity score matching. Outcomes included early postoperative death, a composite of complications, dissected aorta remodeling, long-term survival, and freedom from reoperation.ResultsEarly mortality and complication rates were lower in the hybrid group, but the difference was not statistically significant (9.2% vs 17.4%, P = .073; 15.6% vs 25.7%, P = .066). The rates of postoperative renal insufficiency was significantly lower in the hybrid group than in the frozen elephant trunk group (22.9% vs 38.5%, P = .013); liver insufficiency and paraplegia were significantly lower in the hybrid group than in the frozen elephant trunk group (20.2% vs 33.9%, P = .022; 0% vs 6.4%, P = .014). After matched, the 1-year, 3-year, and 5-year survivals were 87.6%, 86.3%, and 82.2%, respectively, in the hybrid group and 80.7%, 76.5%, and 74.6% (P = .071), respectively, in the frozen elephant trunk group.ConclusionsHybrid aortic arch repair is a viable alternative treatment for patients with DeBakey type I aortic dissection, which improves outcomes and promotes remodeling of the dissected thoracic aorta.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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