Comparison Of Surgical And Conservative Treatment Outcomes For Type A Aortic Intramural Hematoma

Objective The aim of this study was to compare the hospital and long-term clinical effects of different treatment methods for Standford A type aortic intramural hematoma(IMH), as to provide reference for clinical treatment. Methods This is a single center cohort study. We retrospectively selected 73 patients with Type A IMH who were treated in our center from August 1, 2018 to August 1, 2021, including 26 patients treated conservatively and 47 patients treated surgically, and compared them with 154 patients with aortic dissection (AD) who were treated surgically at the same time. Results Compared with IMH patients treated with surgery, the diameter of CTA ascending aorta of IMH patients treated with surgery was higher than that of IMH patients treated with conservative therapy (44.92 ± 7.58 vs 51.22 ± 11.85, P < 0.05), and there was no significant difference in other basic data. The in-hospital mortality of patients with IMH undergoing surgical treatment was lower than that of patients with IMH undergoing conservative treatment (11.5% vs 0%, P < 0.05). The long-term mortality of conservative IMH group was higher than that of surgical IMH group (26.1% vs 8.5%, P < 0.05). There was no significant difference in the basic information of surgery and postoperative complications between patients with AD surgery and those with IMH surgery. The proportion of circulatory arrest time in lower body (19.98 ± 9.39 vs 17.51 ± 3.97) and arch involvement (98 (63.6%) vs 22 (46.8%)) in IMH surgery group was lower than that in AD surgery group (P < 0.05). Conclusions Compared with conservative treatment, surgical treatment of IMH significantly improves the survival rate of patients. If the patient's physical condition and surgical conditions permit, surgical intervention is the first choice. Compared with the effect of AD surgery, IMH surgery is safe.