Abstract: Objectives  To investigate the clinical outcomes of Hybrid Ⅱ and total arch replacement in acute type A aortic dissection(ATAAD) with malperfusion. Methods From January 2016 to January 2020, 127 ATAAD patients with malperfusion who underwent surgical repair were enrolled in this study.There were 56 patients in hybrid debranching group and 71 in total arch replacement group.Their baseline characteristics,perioperative data,and early and mid-term outcomes were compared.Results Compared with the total arch replacement surgery group,the postoperative ventilator assistance time[(32.6±26.7）h vs（61.8±31.1）h],intensive care unit length of stay[(75.3±30.6)h vs (104.4±34.1)h],postoperative renal insufficiency(21.4% vs 46.5%),mortality within 30 days(1.8% vs 12.7%),mortality within 1 year(5.4% vs 18.3%) and permanent neurological dysfunction(8.9% vs 22.5%) in the hybrid debranching group were all statistically significant(P<0.05).There were no differences in re-exploration,hepatic insufficiency,tracheotomy,temporary neurological dysfunction,mortality within 3 years and endoleak.Conclusion Hybrid debranching had better advantages in improving the short-term prognosis of ATAAD patients with malperfusion,but the long-term prognosis needed further study.

Key words: stanford A aortic dissection, malperfusion, total arch replacement, hybrid debranching