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U. Benedetto, M. Codispoti , A . Lechiancole , R . Sinatra University of Rome Sapienza

Current results of elective open total arch replacement versus hybrid thoracic endovascular aortic repair for aortic arch aneurysm. A meta-analysis of comparative studies. . U. Benedetto, M. Codispoti , A . Lechiancole , R . Sinatra University of Rome Sapienza

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U. Benedetto, M. Codispoti , A . Lechiancole , R . Sinatra University of Rome Sapienza

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  1. Current results of elective open total arch replacement versus hybrid thoracic endovascular aortic repair for aortic arch aneurysm. A meta-analysis of comparative studies. U. Benedetto, M. Codispoti, A. Lechiancole, R. Sinatra Universityof Rome Sapienza Papworth Hospital NHS Foundation Trust

  2. Background For aortic arch aneurysm, conventional open total arch replacement has been the standard surgical option. Hybrid thoracic endovascular aortic repair, with aortic arch debranching and endovascular graft placement, has emerged as an attractive option in high risk patients. However, potential advantages of such a strategy over conventional procedure remain completely unknown.

  3. Aim We aimed to gain insights into the role of hybrid repair over conventional approach by means of a meta-analysis of recently published comparative studies.

  4. Methods PubMed, Embase and CochranelibraryweresearchedfromJanuary 1966 untilDecember 2011 lookingforpapersreportingcomparisonofcontemporaryseriesofelectiveaorticarchhybridrepair versus open replacement. Statistics: Relative Odds ratio (OR) and rate ratio (RR) for each study Pooled summary effect estimate by means of a fixed or random effect according to heterogeneity. Outcomes investigated operative mortality permanent neurologic deficit Late mortaliry Reoperation

  5. RESULTS 4 papers enrolled including 378 patients (Hybrid N=109; Open N=269) Murashita J ThoracCardiovascSurg 2011 Lee Ann ThoracSurg 2011 Milewski J ThoracCardiovascSurg 2010 Murphy Arch Surg 2009

  6. Results - Operative Mortality

  7. Results – Permanentneurologic deficit

  8. Results – Late mortality Re-intervention

  9. Conclusions Current evidences do not support a significant improvement in operative mortality with hybrid approach over conventional open aortic arch replacement. Hybrid approach is associated with a slight increase in neurologic deficit and late mortality. Further studies are needed to confirm these findings.

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