Abstract：
OBJECTIVE: Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers.
METHODS: Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency.
RESULTS: In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed.
CONCLUSIONS: Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.
METHODS: Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency.
RESULTS: In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed.
CONCLUSIONS: Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.
摘要：
目的：比较两个三级血管外科中心的混合式和全腔内主动脉弓修复术。
方法：连续接受混合（HG）或全血管内（TEG）全主动脉弓修复术治疗动脉瘤或夹层的患者（2008-2022年）。主要结果指标是30天死亡率。次要结果是主要并发症，技术成功(定义为没有手术转化/死亡，高流量内漏或分支/肢体闭塞)，临床成功（定义为没有致残的临床后遗症），晚期和主动脉相关死亡率/再干预,免于内漏，主动脉直径增长>5毫米，移植物迁移和主动脉上干（SAT）通畅。
结果：总计，包括30名患者，17在HG中和13在TEG中。TEG的干预时间较短(240.5vs341分钟，p=0.01),ICU住院中位数（1vs4.5天，p<0.01）和中位住院时间（8天vs17.5天，p<0.01)。术中无死亡发生。技术成功率为100％；HG的临床成功率为70.6％，TEG为100％（p=0.05）。30天死亡率为13.3%，仅在HG中（p=0.11）。8例患者发生9种主要并发症,HG为5，TEG为3（p=0.99），其中五个笔画，两个在HG和三个在TEG（p=0.62）。晚期死亡率为38.5%，6例HG患者和4例TEG患者,p=0.6。2例晚期主动脉相关死亡发生在HG（p=0.9）。两次与主动脉相关的再干预，未观察到移植物迁移或SAT闭塞。
结论：与混合解决方案相比，全血管内修复似乎缩短了手术时间并提供了更高的临床成功率，没有显著的30天死亡率差异。最常见的主要并发症是中风。
方法：连续接受混合（HG）或全血管内（TEG）全主动脉弓修复术治疗动脉瘤或夹层的患者（2008-2022年）。主要结果指标是30天死亡率。次要结果是主要并发症，技术成功(定义为没有手术转化/死亡，高流量内漏或分支/肢体闭塞)，临床成功（定义为没有致残的临床后遗症），晚期和主动脉相关死亡率/再干预,免于内漏，主动脉直径增长>5毫米，移植物迁移和主动脉上干（SAT）通畅。
结果：总计，包括30名患者，17在HG中和13在TEG中。TEG的干预时间较短(240.5vs341分钟，p=0.01),ICU住院中位数（1vs4.5天，p<0.01）和中位住院时间（8天vs17.5天，p<0.01)。术中无死亡发生。技术成功率为100％；HG的临床成功率为70.6％，TEG为100％（p=0.05）。30天死亡率为13.3%，仅在HG中（p=0.11）。8例患者发生9种主要并发症,HG为5，TEG为3（p=0.99），其中五个笔画，两个在HG和三个在TEG（p=0.62）。晚期死亡率为38.5%，6例HG患者和4例TEG患者,p=0.6。2例晚期主动脉相关死亡发生在HG（p=0.9）。两次与主动脉相关的再干预，未观察到移植物迁移或SAT闭塞。
结论：与混合解决方案相比，全血管内修复似乎缩短了手术时间并提供了更高的临床成功率，没有显著的30天死亡率差异。最常见的主要并发症是中风。
