Abstract
OBJECTIVE: This study aimed to comprehensively evaluate the clinical efficacy and prognostic impact of one-stop hybrid surgery in patients diagnosed with Stanford type A aortic dissection, comparing it with conventional surgical approaches aortic arch replacement plus stented elephant trunk (Sun's procedure). METHODS: In this prospective, randomized controlled trial, a cohort of 140 patients with acute Stanford type A aortic dissection (TAAD) was prospectively enrolled. Patients were randomized 1:1 into two groups based on treatment modality: the Conventional Group (n = 70), which underwent conventional total arch replacement with stented elephant trunk (Sun's procedure) utilizing deep hypothermic circulatory arrest, and the Hybrid Group (n = 70), which received one-stop hybrid surgery (total arch replacement with a standard four-branched graft and retrograde placement of one or two stent grafts into the descending aorta, performed under moderate hypothermia). RESULTS: Baseline demographic and clinical characteristics were largely comparable between the two groups (P > 0.05), although patients in the Hybrid Group were slightly older (P = 0.003). The Hybrid group exhibited significantly reduced operative times (P < 0.001), cardiopulmonary bypass durations (P < 0.001), aortic cross-clamp times (P < 0.001), and ventilator dependency periods (P < 0.001) compared to the Conventional group. Patients in the Hybrid Group also had shorter ICU and hospital stays (P < 0.001). Postoperative complication rates were markedly lower in the Hybrid group, with significant reductions in pulmonary infections (P = 0.009), severe hypoxemia (P = 0.032), stroke (P = 0.045), and reoperation for bleeding (P = 0.038). Postoperative contrast-enhanced Computed Tomography (CTA) assessments at 1 and 3 months post-surgery revealed superior aortic remodeling in the Hybrid group, as evidenced by significantly lower aortic morphology scores (1 month: P < 0.001; 3 months: P < 0.001). Furthermore, the Hybrid group demonstrated a higher 30-day survival rate (91.4% vs. 78.6%, P = 0.024), alongside reduced incidences of endoleak (P = 0.197) and cardiovascular events (P = 0.127). CONCLUSION: One-stop hybrid surgery represents a safe and effective therapeutic strategy for selected patients with Stanford type A aortic dissection, offering superior perioperative outcomes, reduced postoperative morbidity, enhanced short-term survival, and improved quality of life compared to conventional Sun's procedure.