Abstract 19936: Trends in the Management of Acute Type A Intramural Hematoma
Introduction: Acute Type A aortic Intramural Hematoma (IMH), a subgroup of aortic dissection, has evoked discussion regarding optimal management of this condition. While some centers have advocated for medical management, recent guidelines have stated that surgical therapy is generally indicated. This study sought to utilize the International Registry of Acute Aortic Dissection to investigate trends over time in the management of this condition.
Methods: Of 3503 Type A patients enrolled in the International Registry of Acute Aortic Dissection, 141 (4.0%) were identified as having an IMH. This cohort was stratified by date of presentation into three time periods of equal length: Group 1, 1996-2003 (N=28, 19.9%); Group 2, 2004-2009 (N=30, 21.3%); and Group 3, 2010-2015 (N=83, 58.9%).
Results: The study population was 47.5% female with an average age of 70.6 years. Surgery was performed in 71.4% of IMH patients in Group 1, increasing to 81.9% in Group 3 (p=0.492, trend p=0.261), which was not statistically significant. Reasons for receiving medical versus surgical management included advanced age (N=8, 47.1%), comorbid illness (N=12, 57.1%), and patient refusal (N=3, 23.1%). IMH of the arch was identified as a reason for medical management in 6 patients (47.1%). There was no difference in time to diagnosis between groups, with medians of 3.0 hours in Group 1 to 2.6 hours in Group 3 (p=0.971). Notably, surgical mortality decreased between 1996 to 2015, from 35.0% in Group 1 to 13.2% in Group 3 (p=0.087, trend p=0.030).
Conclusions: Operative mortality for Type A IMH decreased over time, providing further support for surgical repair in these patients. In the absence of personalized risk models for surgical and medical outcomes utilizing imaging and genomic data, surgical management appears to be the optimal therapy for acute Type A IMH.
Author Disclosures: A. Evangelista: None. K.M. Harris: None. T.G. Gleason: Other; Significant; National Steering Committee - Medtronic CoreValve trials. U. Sechtem: None. S. Hutchison: None. A.C. Braverman: None. E. Bossone: None. R.E. Pyeritz: None. A. Forteza: None. P. Pappas: None. K. Abdul-Nour: None. D.G. Montgomery: None. E.M. Isselbacher: None. C.A. Nienaber: None. K.A. Eagle: Research Grant; Modest; Medtronic, Terumo. Research Grant; Significant; W.L. Gore & Associates.
- © 2016 by American Heart Association, Inc.