Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases

Objective: Available data on clinical outcomes of hybrid aortic arch repair are limited, especially for patients with aortic dissection. The objective of this review was to provide pooled analysis of periprocedural mortality and neurologic outcomes in hybrid procedures involving the aortic arch for dissection and other aortic diseases. Methods: Studies involving hybrid aortic arch procedures (2002-2011) were systematically searched and reviewed. End points were periprocedural mortality, stroke, and spinal cord ischemia. Results: Atotal of 50 studies including 1886 patients were included. Perioperative mortality ranged from 1.6% to 25.0% with a pooled event ratio of 10.8% (95% confidence intervals [CI], 9.3-12.5). Perioperative stroke, regardless of severity, ranged from 0.8% to 25.0%(pooled ratio 6.9%; 95% CI, 5.7%-8.4), and spinal cord ischemia, including permanent and transitory events, ranged from 1.0% to 25.0% (pooled ratio, 6.8%; 95% CI, 5.6-8.2). Neurologic but no mortality risk was affected by timing and center volume with decreased rates in more recent and higher volume studies. In dissected aorta, perioperative mortality rate was 9.8%(95% CI, 7.7-12.4), stroke 4.3% (95% CI, 3.0-6.3), and spinal cord ischemia 5.8%(95% CI, 4.2-7.9). Perioperative mortality was higher in diseases that extended to the ascending aorta (15.1% vs 7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P = .021), whereas there were no significant differences in the neurologic risks of stroke or spinal cord ischemia. Conclusions: Hybrid repair of the aortic arch carries not negligible risks of perioperative mortality and neurologic morbidity. Risk of neurologic complications has decreased with timing and center volume and may be limited in dissection repairs. However, contemporary information on aortic hybrid arch procedures is mainly provided by small case series or retrospective studies with wide range of results. (J Thorac Cardiovasc Surg 2012; 144: 1286-1300)