Hybrid Aortic Arch Reconstruction: Contemporary Techniques, Outcomes, and Evolving Technologies

Aortic arch intervention remains technically demanding and is associated with higher mortality, neurological complications, and reintervention compared with other thoracic aortic procedures. Hybrid aortic arch repair has emerged to reduce the physiological burden and technical complexity of conventional open arch replacement by combining supra-aortic debranching with endovascular exclusion to create durable proximal landing zones. With advances in device technology and procedural refinement, hybrid strategies have expanded beyond prohibitive-risk patients and are now part of contemporary aortic practice in selected anatomical and clinical scenarios. This review summarizes the evolution and nomenclature of hybrid arch repair, describes commonly used techniques and classification systems, and reviews short- and long-term outcomes, including neurological events and reintervention, in comparison with conventional open repair and endovascular approaches. We also highlight current limitations, patient selection considerations, and emerging device technologies, and we incorporate our institutional experience to contextualize real-world applications.