Hybrid Aortic Arch Repair for Patients Older Than 60 Years in Type A Acute Aortic Dissection

Abstract

Background

The objective of this study was to compare clinical outcomes of total arch replacement (TAR) combined with stented elephant trunk (SET) implantation and hybrid aortic arch repair (HAAR) for type A acute aortic dissection (TA-AAD) in patients older than 60 years.

Patients and Methods

We studied records of patients with TA-AAD older than 60 years in our hospital between January 2016 and December 2018. About 68 patients underwent TAR combined with SET implantation (SET group), and 56 patients underwent HAAR (hybrid group). Outcomes included operative data, postoperative data, and 2 years of follow-up data.

Results

Comparing with the SET group, the hybrid group experienced shorter time on surgery duration (p < 0.001), cardiopulmonary bypass (p < 0.001), aortic cross-clamp (p < 0.001), mechanical ventilation (p < 0.001), ICU stay (p < 0.001), and hospital length of stay (p < 0.001). The hybrid group showed a lower rate of pulmonary infection and renal failure (p = 0.023; p = 0.022, respectively). Blood product use was less in the hybrid group (p < 0.001). The hybrid group had a trend toward reducing the 30-day mortality rate, stroke, and transient mental dysfunction. The hybrid group had a trend toward improving the 2-year survival rate and reintervention-free rate, but the results did not reach a significant level.

Conclusion

Hybrid procedure could be safely performed in patients older than 60 years with TA-AAD. This procedure may be associated with encouraging surgical results and promising outcomes in the early and mid-term.

Keywords

type A aortic dissection - hybrid aortic arch repair - elderly

Contributors' Statement

N.D. contributed to data curation, formal analysis, methodology, software, writing—original draft. J.L. contributed to formal analysis, investigation, software. X.D. contributed to resources. X.J. contributed to resources, supervision. L.W. contributed to data curation, formal analysis, investigation. H.H. contributed to methodology, resources, supervision, writing—review and editing.

Publication History

Received: 28 May 2025

Accepted: 21 December 2025

Accepted Manuscript online:
24 December 2025

Article published online:
07 January 2026

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