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Background:  This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums.   Methods:  From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM).   Results:  After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass ( p  < 0.001) and aortic cross-clamp time ( p  < 0.001), while the operation time was longest in the HAR group ( p  = 0.039). There was no significant difference in 30-day mortality among groups ( p  = 0.783). Furthermore, the incidence of stroke ( p  = 0.679), paraplegia ( p  = 0.104), re-exploration for bleeding ( p  = 0.313), and CRRT ( p  = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM.   Conclusions:  Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.

Early Outcomes of Three Total Arch Replacement Strategies for DeBakey Type I Aortic Dissection