TY - JOUR AU - Zhou, Xun AU - Krishnan, Aravind AU - Hsu, Joshua AU - Burns, Austin AU - Mandal, Kaushik PY - 2019/03/04 Y2 - 2024/03/28 TI - Delayed Surgical Management of Type A Intramural Hematoma Is Not Associated with Worse Outcomes Than Emergent Operation JF - The Heart Surgery Forum JA - HSF VL - 22 IS - 2 SE - DO - 10.1532/hsf.2289 UR - https://journal.hsforum.com/index.php/HSF/article/view/2289 SP - E103-E106 AB - <p class="p1"><span class="s1"><strong>Objectives:</strong> 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.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> 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.</span></p><p class="p1"><span class="s1"><strong>Results:</strong> 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%, <em>P</em> = .020) or limb ischemia (0% versus 12.6%, <em>P</em> = .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 <em>P</em> &gt;.05). Survival analysis showed no difference in survival at 1 year.</span></p><p class="p1"><span class="s1"><strong>Conclusions:</strong> In well-selected patients, delayed operation for type An intramural hematoma is not associated with adverse outcomes.</span></p> ER -