Single-center clinical analysis of hybrid aortic arch repair for aortic arch lesions

Objective To evaluate the safety and short-to-mid-term efficacy of hybrid aortic arch repair (HAR) within a structured, anatomy- and risk-based decision-making framework for heterogeneous aortic arch lesions. Methods Forty-five consecutive patients with aortic arch lesions who underwent HAR between January 2019 and January 2024 were retrospectively included. Lesions comprised degenerative arch aneurysm (46.7%), non-A non-B aortic dissection (33.3%), residual arch disease after Type A repair (13.3%), and penetrating ulcers (6.7%). Preoperative computed tomography angiography and EuroSCORE II were used for anatomical assessment and risk stratification. Based on a two-dimensional principle of anatomical suitability and comorbidity risk, patients were assigned to Type I HAR ( n = 2), Type II HAR ( n = 16), or Type IV HAR ( n = 27). Type I involved debranching with staged Zone 0 thoracic endovascular aortic repair (TEVAR), Type II consisted of total arch replacement with stented elephant trunk followed by TEVAR, and Type IV used cervical bypass with one-stage Zone 2 TEVAR. All decisions were confirmed by a multidisciplinary team. Results All procedures were technically successful, with no intraoperative or 30-day mortality. Type I HAR showed the shortest operative time and least blood loss, whereas Type II had the highest surgical complexity and longest recovery. Postoperative complications were minor, and no stroke, renal failure, or permanent organ injury occurred. During a median follow-up of 18 months (range, 6–36 months), no aortic-related death, endoleak, reintervention, or branch vessel occlusion occurred. Aorta-related survival and freedom from reintervention were both 100%. Conclusion Individualized HAR guided by anatomical features and patient risk provides a safe and effective treatment for complex aortic arch lesions, particularly in high-risk patients unsuitable for open surgery.