Key result
Initial medical therapy for type A IMH linked to ~4% 30-day mortality vs emergent surgery.
Why the study?
The management of type A aortic intramural hematoma involving the ascending aorta has not been well-established.
Does a strategy of medical therapy and timely operation yield favorable long-term clinical outcomes in patients with type A aortic intramural hematoma?
Cohort (n=66)
No
Does a strategy of medical therapy and timely operation yield favorable long-term clinical outcomes in patients with type A aortic intramural hematoma?
A strategy of initial medical therapy with timely surgical intervention for high-risk features like aortic diameter ≥50 mm or disease progression provides excellent long-term survival in patients with type A aortic intramural hematoma.
Supports initial medical management with diameter surveillance in stable type A intramural hematoma; leaves open prospective validation of progression predictors.
BACKGROUND: The management of aortic intramural hematoma (IMH) involving the ascending aorta (type A) has not been well-established. The purpose of this study was to clarify the long-term clinical outcomes of patients with type A IMH who were treated with medical therapy and timely operation. METHODS AND RESULTS: Clinical data including operative mortality, IMH-related events, and long-term survival were retrospectively reviewed in 66 patients with type A IMH, who were admitted to our institution from 1986 to 2006. Emergent surgical repair was performed in 16 (24%) patients because of severe complications, whereas 50 patients were treated with initial medical therapy. In medically treated patients, 15 (30%) patients who demonstrated progression to classic dissection or increase in hematoma size within 30 days underwent surgical repair except for 2 patients who refused surgery. The 30-day mortality rate was 6% with emergent surgery and 4% with supportive medial therapy. There were 7 late deaths and the actuarial survival rates of all patients were 96+/-3%, 94+/-3%, and 89+/-5% at 1, 5, and 10 years, respectively. In medically treated patients, maximum aortic diameter was the only predictor of early and late progression of ascending IMH (hazard ratio, 4.43; 95% CI, 2.04-9.64; P<0.001). Aortic diameter > or =50 mm predicted progression of ascending IMH with the positive and negative value of 83% and 84%, respectively. CONCLUSIONS: Combination of medical therapy and timely operation resulted in favorable long-term clinical outcomes in patients with type A IMH.
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Kitai et al. (2009) conducted a cohort in Type A aortic intramural hematoma (n=66). Initial medical therapy vs. Emergent surgical repair was evaluated on 30-day mortality. Initial medical therapy for type A aortic intramural hematoma yielded a 4% 30-day mortality compared to 6% with emergent surgery, and maximum aortic diameter predicted progression (HR 4.43).
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