Long-term outcomes and prognostic factors of hybrid aortic arch repair: a 15-year cohort study

Objective To evaluate long-term outcomes of hybrid aortic arch repair for aortic arch lesions and identify factors associated with late mortality. Methods We retrospectively enrolled 103 patients with aortic arch lesions who received hybrid aortic arch repair at our center between January 2010 and September 2025. General clinical data, lesion types, surgical methods, perioperative outcomes, and long-term follow-up data were collected. Based on the bypass strategy, patients were divided into an ascending aorta (AA) inflow group ( n  = 48) and a cervical debranching group ( n  = 55). Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate long-term outcomes and identify factors associated with late mortality. Results The mean age was 72.0 ± 10.2 years, and 83.5% were men. Diagnoses included intramural hematoma (40.8%), type B dissection (17.5%), type A dissection (14.6%), arch aneurysm (14.6%), and penetrating ulcer (12.6%). All patients successfully completed the procedure, with no intraoperative or 30-day deaths. During a median follow-up of 75.8 months (IQR, 29–128), procedure-related stroke occurred in 8 patients (7.8%), renal dysfunction in 18 (17.5%), and spinal cord ischemia in none. Eleven patients (10.7%) died, and 8 (7.8%) underwent reintervention, mainly for retrograde type A dissection, endoleak, or new-entry dilation. Survival at 1, 3, 5, and 10 years was 98.0%, 94.6%, 89.0%, and 85.8%; freedom from reintervention was 97.9%, 94.2%, 91.5%, and 89.9%. Cervical debranching was associated with better survival than ascending aortic inflow (log-rank P  = 0.024), with similar freedom from reintervention (log-rank P  = 0.88). In an exploratory multivariable Cox model, older age, ascending aorta inflow, and preoperative renal dysfunction were associated with late mortality. Conclusions Hybrid aortic arch repair was associated with favorable long-term survival, durable freedom from reintervention, and acceptable neurological outcomes in this single-center cohort. The observed survival advantage in the cervical debranching group should be interpreted cautiously, as ascending aorta inflow was preferentially used in patients with more complex proximal aortic disease. These findings should be considered hypothesis-generating and require validation in larger multicenter studies.