Open surgical repair vs. hybrid repair for treatment of aortic arch aneurysm: a systematic review and meta-analysis

INTRODUCTION: This review aimed to evaluate open surgical repair (OSR) and hybrid repair (HR) in the treatment of unruptured aortic arch aneurysms. EVIDENCE ACQUISITION: A systematic search was undertaken using the following databases, PubMed, Cochrane Database of Systematic Reviews (CDSR), Web of Science and Scopus to identify all studies that were published with regard to OSR and HR up to August 2019. EVIDENCE SYNTHESIS: Six retrospective observational studies published from 2009 to 2018 were included. A total of 171 (34.1%) patients treated with HR and 331 (65.9%) patients treated with OSR. No significant difference was found in 30-day mortality (P=0.31, 95%, CI [0.59, 2.29]) and all-cause mortality at 12 months (P=0.27, 95% CI [1.07, 4.61]). Postoperative stroke occurred in 22/331 (6.6%) cases in OSR group compared to 20/171 (11.9%) cases in the HR group (P=0.80; 95% CI [0.90, 2.84], I²=0%). Postoperative paraplegia (P=0.21; 95% CI [0.35, 4.29] and renal dysfunction (P=0.20; 95% CI [0.39, 1.36]) were insignificant between OSR and HR. Patients treated with OSR (7.5±5.4 days) required significantly longer length of ICU stay in comparison to patients treated with HR (4.6±2.4 days) (P<0.0001, 95% CI [-6.44, 0.57]). CONCLUSIONS: The results of this review suggest no evidence that HR is superior to OSR. HR led to in a decrease in postoperative paraplegia, renal dysfunction and postoperative bleeding compared to OSR although this difference was insignificant. In addition, HR significantly reduced the number days in ICU.