Total arch replacement versus debranching thoracic endovascular aortic repair for an aortic arch aneurysm

BACKGROUND: Conventional total arch replacement (COTAR) is a standard treatment for aortic arch aneurysms. Although thoracic endovascular aortic repair (TEVAR) is a minimally invasive surgery, the frequency of perioperative cerebral infarction is high. METHODS: Between July 2009 and July 2021, 113 patients eligible for COTAR (N.=85) or debranching TEVAR (N.=28) were included in this study. We evaluated mortality, neurological complications, survival, and freedom from aortic re-intervention. A total 17 patients in the debranching TEVAR group were matched to 17 patients who underwent conventional total arch replacement. RESULTS: Surgical outcomes demonstrated a shorter intensive care unit stay and respiration time in the debranching TEVAR group (P<0.001 and P<0.001, respectively). The 30-day and in-hospital mortality rates were 0% between groups. Permanent neurological dysfunction was not significantly different between the two groups (5.9%, P=1.00). The early and long-term survival was not significantly different between the two groups at 1 year and 5 years (conventional total arch replacement: 94.2% and 73.3%, respectively; debranching thoracic endovascular aortic repair: 88.2% and 60.0%, respectively; P=0.417). Freedom from aortic reintervention was not significantly different between the groups (conventional total arch replacement: 100% and 92.9%; debranching thoracic endovascular aortic repair: 100% and 92.3%; P=0.935) in propensity CONCLUSIONS: Surgical outcomes showed no significant difference between the groups except for intensive care unit stay and respiration time after debranching thoracic endovascular aortic repair. Long-term survival and the re-intervention free rate were similar between groups. (Cite this article as: Chiba K, Nishimaki H, Tomita M, Nakamura R, Kinebuchi S, Kita S, et al. Total arch replacement versus debranching thoracic endovascular aortic repair for an aortic arch aneurysm. Ital J Vasc Endovasc Surg 2023;30:21-30. DOI: 10.23736/S1824-4777.23.01579-6)