Survival outcomes of hybrid versus total arch replacement in type A aortic dissection: A meta-analysis of reconstructed individual participant data

IntroductionThe optimal extent of aortic arch intervention for acute type A aortic dissection (ATAAD) remains uncertain. Total arch replacement with a frozen elephant trunk (TAR + FET) prolongs circulatory-arrest time, whereas hybrid arch repair (HAR)-supra-aortic debranching in combination with antegrade endovascular stent grafting-reduces ischemic time but may increase the risk of late reintervention.ObjectiveThis study aims to compare mid-term survival and freedom from reintervention after HAR versus TAR in ATAAD.MethodsPubMed, Embase, and Scopus were searched from their inception to May 2025. Kaplan-Meier Curves were digitized, and individual-participant data were reconstructed with a validated algorithm. Pooled hazard ratios (HR) were derived from a one-stage flexible parametric model; robustness was assessed with two-stage random-effects meta-analysis, leave-one-out tests.ResultsFive propensity-matched studies (<i>n</i> = 697; 338 HAR, 359 TAR) met inclusion criteria. Hybrid arch repair shortened cardiopulmonary bypass and avoided circulatory arrest time. Five-year survival was 86.5% for HAR versus 76.2% for TAR (log-rank <i>p</i> < 0.001). Hybrid arch repair provided a significant early-to-mid-term survival advantage over TAR in ATAAD (HR 0.46 (95% CI 0.31-0.69; <i>p</i> < 0.001)), corresponding to about 6 months of survival benefit at 5 years. Hybrid arch repair was associated with greater likelihood of early reintervention (HR 4.07, 95% CI 0.55-30.34).ConclusionHybrid arch repair offers a significant early-to-mid-term survival advantage over TAR in ATAAD. In patients requiring aortic arch replacement, HAR may be favored over TAR/FET, while extensive TAR/FET procedures are reserved for anatomically unsuitable cases.