Hybrid procedure in DeBakey type I dissection: superior outcomes to total arch replacement plus frozen elephant trunk

Objective To compare the early and midterm results between the two techniques for Debakey I dissection. Methods The records of patients with DeBakey type I dissection between January 2010 and December 2016 were retrospectively studied. Of these, 815 patients (86.9%) underwent open total arch replacement (TAR) + frozen elephant trunk(FET) stent implantation (FET group) and 122 patients (13.1%) underwent hybrid aortic arch repair (hybrid group). 109 pairs of patients from the two groups for propensity score matching analysis were further selected. Results (1) The early results from total cohort showed that the average age of all patients was 48.6 years, average age was higher in the Hybrid group than in the FET group (61.3 years vs 46.7 years, P<0.001). Ninety-eight patients died during the early postoperative period (98/937, mortality rate was 10.5%), including 11 patients in the Hybrid group and 87 in the FET group [9% (11/122) vs 10.7% (87/815), P=0.577)]. The composite rate of postoperative complications for the entire cohort was 19.6% (184/937), and the difference between the Hybrid and FET groups was statistically insignificant [15.6% (19/122) vs 20.2% (165/815), P=0.226]. Persistent neurologic deficits after surgery were not reported in the Hybrid group, but were found in 72 patients in the FET group (72/815, 8.8%). (2)The early results showed that mortality and the composite rate of complications were much lower in the hybrid group than in the FET group, but the differences were not statistically significant [9.2%(10/109) vs 17.4% (19/109), P=0.073; 15.6%(17/109) vs 25.7%(28/109), P=0.066]. The incidences of renal dysfunction, hepatic dysfunction and paraplegia were lower in the hybrid group compared with the FET group (P=0.013, P=0.022, and P=0.014). The matching analysis revealed that the rates of complete false-lumen thrombosis in the thoracic aorta were higher in the hybrid group than in the FET group [stented segment: 87.8%(79/90) vs 75.3% (58/77), P=0.044; lower-thoracic segment: 43.3% (39/90) vs 27.3%(21/77), P=0.038]. The survival rates at 3-, 5- and 7-year follow-up were 95.7%, 91.7%, 91.7% in hybrid group and 95.6%, 93.7%, 82% in FET group, respectively (P=0.320). Conclusions The hybrid technique for DeBakey type I aortic dissection can decrease early mortality and composite morbidity. Additionally, this technique can promote complete false-lumen thrombosis of thoracic dissections more effectively than the conventional approach. Key words: Aortic dissection; Total arch replacement; Hybrid aortic repair; Deep hypothermic circulatory arrest; Frozen elephant trunk