Abstract 4575: Mid-Term Results of Acute Intramural Hematoma Involving the Ascending Aorta
Background The treatment strategy of acute intramural hematoma (IMH) involving the ascending aorta remains controversial. The objective of this study was to evaluate the effectiveness of initial surgical treatment for this condition.
Methods and Results Clinical data were compared retrospectively between 69 patients with initial surgical repair and 11 patients with medical treatment for acute type A IMH at our institution from 2000 to 2008. Mean age was 68.8±10.8 years, with 50 female patients and 15 in cardiogenic shock at presentation. The indication of the initial surgical therapy was cardiac tamponade, aortic rupture, diameter of the ascending aorta 45 mm or greater, or presence of the ulcerlike projection. Mean follow-up period was 75.9±56.8 months. All but two patients underwent operation within 72 hours from the onset of symptoms in the surgical group. One patient who demonstrated progression to AD underwent timed surgical repair in the medical group. The overall in-hospital mortality rate in the surgical group was significantly lower than that in the medical group (0% vs. 18.2%, p=0.017). Stroke occurred in 4 patients and transient neurologic dysfunction in 3 in the surgical group. Postoperative computed tomographic scan showed residual distal hematoma progression to classical double-barrel dissection in 2 patients in the surgical group. During the follow-up period, one patient died and two had a new type B aortic dissection in the surgical group. The survival rates at 5-year in the surgical group were significantly higher than that in the medical group (97.2±2.7% vs. 81.8±11.6%, P=0.006). 5-year estimated freedom from intramural hematoma-related events, defined as new IMH, progression to classical dissection, death from aortic rupture, or sudden death, in the surgical group were also higher than that in the medical group (93.8±3.0% vs. 72.7±13.4%, P=0.010).
Conclusions Initial surgical treatment strategy of acute aortic intramural hematoma involving the ascending aorta results in lower mortality rates and excellent midterm survival as compared with medical treatment.