Abstract OBJECTIVES We described short- and mid-term outcomes of Hybrid thoraco-abdominal aortic aneurysm repair (HTAR), combining visceral debranching and thoracic endovascular aortic repair (TEVAR). METHODS This multicentric, retrospective cohort study analysed two Italian referral centres’ prospectively collected data on patients undergoing HTAR with at least one renal artery bypass, between 2003 and 2024. These patients were deemed unfit for open surgery. Primary outcomes were early (≤30 days) and mid-term survival, and freedom from aorta-related mortality (ARM). Secondary outcomes included spinal cord injury, freedom from reintervention and bypass patency. RESULTS The population included 86 patients, 12 (13.9%) of which were urgent. Median age was 69 years. In-hospital mortality occurred in 20 patients (23.3%), with major complications in 33 (38.4%), mainly AKI (20; 23.3%) and pneumonia (9; 10.5%). Spinal cord injury rate was 5.8%. A two-stage strategy was used in 68 patients (79.1%). Median follow-up was 17.5 months. At 1-, 2-, and 5-years, survival was 68.6%, 67% and 50.9%, freedom from ARM was 82.4%, 82.4% and 82.4%; freedom from reintervention was 97.4%, 97.4% and 87.7% and patency was 95%, 89% and 84%. Late reintervention occurred in 12.1% of patients. Female gender and rupture were significant predictors of reintervention and mortality, respectively. Quartile of experience correlated with improved outcomes. CONCLUSIONS HTAR provides an alternative to open repair in high-risk TAAA patients, with acceptable early and mid-term outcomes. While in-hospital mortality remains notable, spinal cord injury rates are low thanks to the two-stage approach, and freedom from ARM and bypass patency are satisfactory.
Murana et al. (Sun,) studied this question.