Jennifer Lynn Kim MD , Michael Baiocchi PhD , Matthew Leipzig BS , Matthew Duda MD , Edgar Aranda-Michel MD, PhD , Emily Tognozzi MS , Kelly Higa MD, PhD , Yuanjia Zhu MD, PhD , John Ward MacArthur MD , Y. Joseph Woo MD , Michael P. Fischbein MD, PhD
{"title":"超过21年的A型颅内血肿：单一中心的经验","authors":"Jennifer Lynn Kim MD , Michael Baiocchi PhD , Matthew Leipzig BS , Matthew Duda MD , Edgar Aranda-Michel MD, PhD , Emily Tognozzi MS , Kelly Higa MD, PhD , Yuanjia Zhu MD, PhD , John Ward MacArthur MD , Y. Joseph Woo MD , Michael P. Fischbein MD, PhD","doi":"10.1016/j.xjon.2024.09.033","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option.</div></div><div><h3>Methods</h3><div>Between January 2000 and December 2020, a total of 903 patients were treated for acute aortic syndrome at Stanford Hospital. Baseline characteristics, operative details, short-term postoperative outcomes, mid-term survival, and reoperation rates were examined for this cohort. Cardinality matching was used to control for baseline characteristics and presentation symptoms. Fine balance matching was used to control for cannulation strategy.</div></div><div><h3>Results</h3><div>A total of 187 TAIMH patients were treated surgically and 27 were managed medically. The ATAAD arm included 642 patients who underwent surgery and 47 who were managed nonoperatively. ATAAD operative patients were more commonly male and younger compared to the TAIMH operative patients; however, other baseline medical history was similar in the 2 arms. ATAAD patients presented with higher rates of malperfusion and aortic regurgitation. Cross-clamp and cardiopulmonary bypass times were longer in the ATAAD arm, and these patients underwent more root replacements. Short-term postoperative outcomes were similar in the 2 arms, and there was no significant difference in unadjusted long-term survival and freedom from reoperation. With cardinality matching for preoperative history and presentation symptoms, mid-term survival was better for TAIMH patients. With fine balance matching for cannulation strategy, there was no significant difference between the groups in mid-term survival or stroke.</div></div><div><h3>Conclusions</h3><div>In conclusion, a surgical management strategy for acute TAIMH results in excellent postoperative outcomes and supports an aggressive emergent operative strategy in aortic centers of excellence.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 1-18"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Type A intramural hematoma over 21 years: A single center's experience\",\"authors\":\"Jennifer Lynn Kim MD , Michael Baiocchi PhD , Matthew Leipzig BS , Matthew Duda MD , Edgar Aranda-Michel MD, PhD , Emily Tognozzi MS , Kelly Higa MD, PhD , Yuanjia Zhu MD, PhD , John Ward MacArthur MD , Y. Joseph Woo MD , Michael P. Fischbein MD, PhD\",\"doi\":\"10.1016/j.xjon.2024.09.033\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option.</div></div><div><h3>Methods</h3><div>Between January 2000 and December 2020, a total of 903 patients were treated for acute aortic syndrome at Stanford Hospital. Baseline characteristics, operative details, short-term postoperative outcomes, mid-term survival, and reoperation rates were examined for this cohort. Cardinality matching was used to control for baseline characteristics and presentation symptoms. Fine balance matching was used to control for cannulation strategy.</div></div><div><h3>Results</h3><div>A total of 187 TAIMH patients were treated surgically and 27 were managed medically. The ATAAD arm included 642 patients who underwent surgery and 47 who were managed nonoperatively. ATAAD operative patients were more commonly male and younger compared to the TAIMH operative patients; however, other baseline medical history was similar in the 2 arms. ATAAD patients presented with higher rates of malperfusion and aortic regurgitation. Cross-clamp and cardiopulmonary bypass times were longer in the ATAAD arm, and these patients underwent more root replacements. Short-term postoperative outcomes were similar in the 2 arms, and there was no significant difference in unadjusted long-term survival and freedom from reoperation. With cardinality matching for preoperative history and presentation symptoms, mid-term survival was better for TAIMH patients. With fine balance matching for cannulation strategy, there was no significant difference between the groups in mid-term survival or stroke.</div></div><div><h3>Conclusions</h3><div>In conclusion, a surgical management strategy for acute TAIMH results in excellent postoperative outcomes and supports an aggressive emergent operative strategy in aortic centers of excellence.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"23 \",\"pages\":\"Pages 1-18\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273624003565\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624003565","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Type A intramural hematoma over 21 years: A single center's experience
Objective
To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option.
Methods
Between January 2000 and December 2020, a total of 903 patients were treated for acute aortic syndrome at Stanford Hospital. Baseline characteristics, operative details, short-term postoperative outcomes, mid-term survival, and reoperation rates were examined for this cohort. Cardinality matching was used to control for baseline characteristics and presentation symptoms. Fine balance matching was used to control for cannulation strategy.
Results
A total of 187 TAIMH patients were treated surgically and 27 were managed medically. The ATAAD arm included 642 patients who underwent surgery and 47 who were managed nonoperatively. ATAAD operative patients were more commonly male and younger compared to the TAIMH operative patients; however, other baseline medical history was similar in the 2 arms. ATAAD patients presented with higher rates of malperfusion and aortic regurgitation. Cross-clamp and cardiopulmonary bypass times were longer in the ATAAD arm, and these patients underwent more root replacements. Short-term postoperative outcomes were similar in the 2 arms, and there was no significant difference in unadjusted long-term survival and freedom from reoperation. With cardinality matching for preoperative history and presentation symptoms, mid-term survival was better for TAIMH patients. With fine balance matching for cannulation strategy, there was no significant difference between the groups in mid-term survival or stroke.
Conclusions
In conclusion, a surgical management strategy for acute TAIMH results in excellent postoperative outcomes and supports an aggressive emergent operative strategy in aortic centers of excellence.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
