Acute type A intramural hematoma: The less-deadly acute aortic syndrome?

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-02-01 Epub Date: 2024-01-25 DOI:10.1016/j.jtcvs.2024.01.032

Rana-Armaghan Ahmad, Felix Orelaru, Akul Arora, Carol Ling, Karen M Kim, Shinichi Fukuhara, Himanshu Patel, G Michael Deeb, Bo Yang

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引用次数: 0

Abstract

Objective: To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD).

Methods: From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons' Data Warehouse and medical chart review.

Results: Compared with the classic ATAAD group, the IMH group was older (65 vs 59 years, P < .001) and more likely to be female (45% vs 32%, P = .005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs 25%, P < .001), acute stroke (2.8% vs 8.3%, P = .05), acute renal failure (5.7% vs 13%, P = .04), and malperfusion syndrome (8.5% vs 26%, P < .001) but more cardiac tamponade (18% vs 11%, P = .03). The IMH group had less aortic root replacement (15% vs 33%, P < .001), zone 2 arch replacements (9.4% vs 18%, P = .02), and shorter crossclamp times (120 minutes vs 150 minutes, P < .001). The operative mortality was significantly lower in the IMH group (0.9% vs 8.8%, P = .005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, P = .03. The 10-year survival was similar between the 2 groups (65% vs 61%, P = .35). The hazard ratio of IMH for midterm mortality after surgery was 0.73, P = .12.

Conclusions: Acute type A IMH could be treated with emergency open aortic repair with excellent short- and midterm outcomes.

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急性 A 型壁内血肿：致命性较低的急性主动脉综合征？

目的评估手术治疗急性A型壁内血肿（IMH）与典型急性A型主动脉夹层（ATAAD）的短期和中期疗效：1996年至2023年2月，共有106名急性A型IMH患者和795名典型ATAAD患者在我院接受了主动脉开放修补术。数据来自当地胸外科医师协会的数据仓库和病历审查：结果：与传统的ATAAD组相比，IMH组年龄更大（65岁对59岁，p结论：急性A型IMH可以通过手术治疗：急性A型IMH可通过急诊开放式主动脉修补术治疗，短期和中期疗效极佳。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.