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 University of 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 Cochrane library were searched from January 1966 until December 2011 looking for papers reporting comparison of contemporary series of elective aortic arch hybrid repair 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 Thorac Cardiovasc Surg 2011 Lee Ann Thorac Surg 2011 Milewski J Thorac Cardiovasc Surg 2010 Murphy Arch Surg 2009

6. Results - Operative Mortality

7. Results – Permanent neurologic 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.