Survival outcomes of hybrid versus total arch replacement in type A aortic dissection: A meta-analysis of reconstructed individual participant data

Abstract

Introduction

The optimal extent of aortic arch intervention for acute type A aortic dissection (ATAAD) remains uncertain. Total arch replacement with a frozen elephant trunk (TAR + FET) prolongs circulatory-arrest time, whereas hybrid arch repair (HAR)—supra-aortic debranching in combination with antegrade endovascular stent grafting—reduces ischemic time but may increase the risk of late reintervention.

Objective

This study aims to compare mid-term survival and freedom from reintervention after HAR versus TAR in ATAAD.

Methods

PubMed, Embase, and Scopus were searched from their inception to May 2025. Kaplan–Meier Curves were digitized, and individual-participant data were reconstructed with a validated algorithm. Pooled hazard ratios (HR) were derived from a one-stage flexible parametric model; robustness was assessed with two-stage random-effects meta-analysis, leave-one-out tests.

Results

Five propensity-matched studies (n = 697; 338 HAR, 359 TAR) met inclusion criteria. Hybrid arch repair shortened cardiopulmonary bypass and avoided circulatory arrest time. Five-year survival was 86.5% for HAR versus 76.2% for TAR (log-rank p < 0.001). Hybrid arch repair provided a significant early-to-mid-term survival advantage over TAR in ATAAD (HR 0.46 (95% CI 0.31–0.69; p < 0.001)), corresponding to about 6 months of survival benefit at 5 years. Hybrid arch repair was associated with greater likelihood of early reintervention (HR 4.07, 95% CI 0.55–30.34).

Conclusion

Hybrid arch repair offers a significant early-to-mid-term survival advantage over TAR in ATAAD. In patients requiring aortic arch replacement, HAR may be favored over TAR/FET, while extensive TAR/FET procedures are reserved for anatomically unsuitable cases.