Delayed Surgical Management of Type A Intramural Hematoma Is Not Associated with Worse Outcomes Than Emergent Operation
DOI:
https://doi.org/10.1532/hsf.2289Abstract
Objectives: Management of acute aortic intramural hematomas (IMHs) involving the ascending aorta and root remains controversial. Some series have suggested that delaying operative intervention beyond the first 24-hours may be beneficial.
Methods: A retrospective single-institution analysis was performed to identify patients presenting with type A IMH. These patients were classified by whether they underwent surgery within 24 hours or delayed operative intervention. Patients with additional indications for emergent operation, such as acute aortic regurgitation or malperfusion syndromes, were excluded. Outcomes were assessed with logistic regression, and the Kaplan–Meier method was used to analyze long-term survival.
Results: Of the 129 patients with acute type A aortic pathology, 36 (27.9%) presented with isolated IMH. IMH patients were less likely to present with acute aortic regurgitation (8.6% versus 27.9%, P = .020) or limb ischemia (0% versus 12.6%, P = .027). Of the IMH patients without other emergent operative indications, 23 (67.6%) underwent surgery within 24 hours. Delayed operative repair was not associated with increased risk of mortality, stroke, or renal failure (all P >.05). Survival analysis showed no difference in survival at 1 year.
Conclusions: In well-selected patients, delayed operation for type An intramural hematoma is not associated with adverse outcomes.
References
Evangelista A, Mukherjee D, Mehta RH, et al. 2005. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 111(8):1063-70.
Ferrera C, Vilacosta I, Gómez-Polo JC, et al. 2017. Evolution and prognosis of intramural aortic hematoma. Insights from a midterm cohort study. Int J Cardiol 249:410-3.
Leshnower BG. 2018. Type A intramural hematoma: an unstable, unpredictable enigma. J Thorac Cardiovasc Surg 155(3):910-1.
Matsushita A, Fukui T, Tabata M, Sato Y, Takanashi S. 2016. Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: a propensity score-matched analysis. J Thorac Cardiovasc Surg 151(2):351-8.
Roselli EE, Svensson LG. 2016. Aggressive surgical repair for ascending intramural hematoma is still a great option. J Thorac Cardiovasc Surg 151(2):359-60.
Sandhu HK, Tanaka A, Charlton-Ouw KM, et al. 2016. Outcomes and management of type A intramural hematoma. Ann Cardiothorac Surg 5(4):317-27.
Sundt TM. 2007. Intramural hematoma and penetrating atherosclerotic ulcer of the aorta. Ann Thorac Surg 83(2):S835-41; discussion S846-50.
Trimarchi S, Nienaber CA, Rampoldi V, et al. 2005. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 129(1):112-22.
Xie X, Bai J. 2018. Serial images demonstrating progression of type A intramural hematoma to type B aortic dissection. J Thorac Cardiovasc Surg 155(3):907-9. Especially see Video 2.
