Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections

Abstract Objectives. Composite frozen elephant trunk is an increasingly popular solution for complex aortic pathologies. This review aims to compare outcomes of zone 0 type II hybrid (hybrid II) with the composite frozen elephant trunk (FET) technique in managing acute Stanford type A aortic dissections. Methods. PubMed and Embase were systematically searched using PRISMA protocol. 11 relevant studies describing the outcomes of hybrid II arch repair and FET techniques in patients with type A aortic dissection were included in the meta-analysis. The study focused on early post-operative 30-day outcomes analysing mortality, stroke, spinal cord injury, renal impairment requiring dialysis, bleeding and lung infection. Results. 1305 patients were included in the analysis – 343 receiving hybrid II repair and 962 treated with the FET. Meta-analysis of proportions showed Hybrid II was associated with less early mortality [5.0 (CI 3.1–7.8) vs 8.1 (CI 6.5–10.0) %], stroke [2.3 (CI 1.1–4.6) vs 7.0 (CI 5.5–8.8) %], spinal cord injury [2.0 (CI 0.9–4.3) vs 3.8 (CI 2.8–5.3) %], renal impairment requiring dialysis [7.9 (CI 5.5–11.2) vs 11.8 (CI 9.8–14.0) %], reoperation for bleeding [3.9 (CI 1.8–8.4) vs 10.6 (CI 8.1–13.8) %] and lung infection [14.8 (CI 10.8–20.0) vs 20.7 (CI 16.9–25.1) %]. Conclusion. Hybrid II should be considered in favour of FET technique in acute Stanford type A dissection patients who are at higher risk due to age and comorbidities.