Meta-analysis of open surgical repair versus hybrid arch repair for aortic arch aneurysm

Abstract

Objective: To conduct a meta-analysis of available comparative studies evaluating hybrid arch repair versus open surgical repair of aortic arch aneurysm.

Methods: A literature search was performed using PubMed, Embase and Web of Science to identify any studies comparing the results of hybrid arch repair with open surgical repair of aortic arch aneurysm. Study quality was assessed with the Newcastle-Ottawa Scale. Statistical heterogeneity was estimated using the chi-square test. A random-effects model was used to illustrate heterogeneity. Publication bias was evaluated by funnel plots.

Results: Seven retrospective cohort studies from 2009 to 2016 comprising 727 patients were included. Among these patients, 269 were treated with hybrid arch repair and 458 with open surgical repair. There was no significant difference in operative mortality (OR 0.75; 95% CI 0.41-1.39; P = 0.37), permanent neurological deficit (OR 1.24; 95% CI 0.73-2.13; P = 0.42), late mortality (2 years) (OR 3.41; 95% CI 0.83-14.03; P = 0.09) or renal failure (OR 0.80; 95% CI 0.40-1.61; P = 0.53). Interestingly, the meta-analysis indicated that the hybrid group needed more reinterventions (OR 3.43; 95% CI 1.72-6.84; P = 0.0005).

Conclusions: We found no strong evidence indicating that hybrid arch repair is superior to open surgical repair. Furthermore, the hybrid arch repair resulted in more reinterventions despite the fact that it was a less invasive procedure; it also required fewer days in the hospital. Further studies with large numbers of participants and long-term follow-ups are necessary to confirm the effectiveness of hybrid arch repair.

Keywords: Aortic arch aneurysm; Hybrid arch repair; Open surgical repair.