Comparison of early and intermediate-term outcomes between hybrid arch debranching and total arch replacement: A systematic review and meta-analysis of propensity-matched studies
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Issued Date
2025-09-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-105015057011
Pubmed ID
40906679
Journal Title
Plos One
Volume
20
Issue
9 September
Rights Holder(s)
SCOPUS
Bibliographic Citation
Plos One Vol.20 No.9 September (2025)
Suggested Citation
Kaewboonlert N., Slisatkorn W., Tantraworasin A., Pleehachinda P., Prapassaro T., Pongsuwan N., Chatkaewpaisal C., Ruangpratyakul T. Comparison of early and intermediate-term outcomes between hybrid arch debranching and total arch replacement: A systematic review and meta-analysis of propensity-matched studies. Plos One Vol.20 No.9 September (2025). doi:10.1371/journal.pone.0314341 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112078
Title
Comparison of early and intermediate-term outcomes between hybrid arch debranching and total arch replacement: A systematic review and meta-analysis of propensity-matched studies
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives To systematically review propensity score-matched studies comparing hybrid arch repair (HAR) with total arch replacement (TAR) for aortic arch pathologies, summarizing early outcomes and intermediate-term results. Methods We searched PubMed, Embase, the Cochrane Library, and Google Scholar to April 2024. The primary outcome was in-hospital mortality, evaluated by a random-effects model to calculate the odds ratio (OR). Time-to-event outcomes were synthesized as hazard ratios (HR) using inverse variance method. Results Eight studies comprising 860 patients were included. There was no significant difference in in-hospital mortality between HAR and TAR groups (OR 0.66; 95% CI 0.33-1.31; p = 0.240). HAR was associated with a lower incidence of renal failure (OR 0.51; 95% CI 0.30-0.88; p = 0.020). In the isolated type A aortic dissection (ITAAD) subgroup, HAR showed a non-significant trend toward lower in-hospital mortality (OR 0.66; 95% CI 0.33-1.31, p = 0.24). In mixed degeneration-dissection (MDAD), TAR showed a non-significant trend toward lower risk of permanent neurological dysfunction (PND) (OR 2.84; 95% CI 0.89-9.10; p = 0.080) and a significantly lower three-year re-interventions rate (HR 2.99; 95% CI 1.48-6.04; p < 0.001). Other postoperative complications did not differ significantly: sternal re-entry for hemorrhage (OR 0.55; 95% CI 0.21-1.43; p=0.220), and tracheostomy (OR 1.08; 95% CI 0.43-2.72; p=0.870). Conclusions HAR was associated with a lower risk of renal failure. In ITAAD, HAR showed a trend toward lower in-hospital mortality, whereas in MDAD cohorts, TAR showed a significantly lower three-year re-intervention rate. These findings should be interpreted with caution given the small number of studies and underlying heterogeneity. Further observational studies or randomized trials are warranted.