Prognostic analysis of hybrid surgery versus Sun's surgery for acute dissection in the aortic arch

Objective To retrospectively analyze the postoperative early and mid- and long-term prognosis of patients with acute dissection in the aortic arch through hybrid surgery and Sun's surgery,and provide evidence for the selection of surgical approaches for the clinical treatment of patients with acute dissection in the aortic arch. Methods Through propensity score matching, 693 patients with acute dissection in the aortic arch who were admitted to Naning First Hospital Affiliated to Naning Medical University from January 2015 to June 2023 were selected and their clinical data were retrospectively analyzed. According to surgical approaches, they were divided into two groups: a hybrid surgery group (n=144) and a Sun's surgery group (n=549). Both groups were compared for the outcomes during hospitalization and mid- and long-term prognosis. The primary outcome was all-cause mortality, the secondary outcomes were cardiovascular death and secondary aortic surgery, and the tertiary outcomes included death and complications during hospitalization. Results After propensity score matching, 127 case-pairs were generated for this study. Patients in the Sun's surgery group showed longer duration of surgery, extracorporeal circulation time, and aortic blockade time than the hybrid surgery group (P<0.05). Meanwhile, those in the Sun's surgery group presented significant increases in delirium rate, blood transfusion rate, new dialysis rate, the rate of prolonged mechanical ventilation, the length of intensive care unit stay, and the length of hospitalization (P<0.05). No statistical differences were found between the hybrid and Sun's surgery groups in terms of death during hospitalization, mid- and long-term all-cause death, and cardiovascular death (P>0.05). However, Sun's surgery was associated with a lower rate of secondary aortic surgery (HR 0.29, 95%CI 0.10-0.87, P=0.027). These results were validated in the unmatched cohort. Conclusions Hybrid surgery does not improve mid- and long-term survival rate and increase the risk of mid- and long-term secondary aortic surgery. However, compared with Sun's surgery, hybrid surgery reduces the duration of operation and the length of hospitalization stay, and decreases postoperative complications, with advantages in the early postoperative period, and should be rationally used in clinical practice depending on the patient's condition.