Objective

To evaluate the short- and mid-term outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD).

Methods

From 1996-February 2023, a total of 106 acute type A IMH patients and 795 classic ATAAD patients presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons’ Data Warehouse and medical chart review.

Results

Compared to the classic ATAAD group, the IMH group was older (65 vs. 59years, p<0.001) and more likely to be female (45% vs. 32%, p=0.005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs. 25%, p<0.001), acute stroke (2.8% vs. 8.3%, p=0.05), acute renal failure (5.7% vs. 13%, p=0.04), and malperfusion syndrome (8.5% vs. 26%, p<0.001), but more cardiac tamponade (18% vs. 11%, p=0.03). The IMH group had less aortic root replacement (15% vs. 33%, p<0.001), Zone 2 arch replacements (9.4% vs. 18%, p=0.02), and shorter cross-clamp times (120minutes vs. 150minutes, p<0.001). The operative mortality was significantly lower in the IMH group (0.9% vs. 8.8%, p=0.005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, p=0.03. The 10-year survival was similar between the two groups (65% vs. 61%, p=0.35). The hazard ratio of IMH for mid-term mortality after surgery was 0.73, p=0.12.

Conclusions

Acute type A IMH could be treated with emergency open aortic repair with excellent short and mid-term outcomes.

中文翻译：

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急性 A 型壁内血肿：不太致命的急性主动脉综合征？

客观的

旨在评估手术治疗的急性 A 型壁内血肿 (IMH) 与经典的急性 A 型主动脉夹层 (ATAAD) 的短期和中期结果。

方法

1996年至2023年2月，共有106例急性A型IMH患者和795例经典ATAAD患者在我院接受开放主动脉修复术。数据来自当地胸外科医生协会的数据仓库和医疗图表审查。

结果

与经典 ATAAD 组相比，IMH 组年龄更大（65 岁 vs. 59 岁，p<0.001），女性比例更高（45% vs. 32%，p=0.005），严重主动脉瓣关闭不全等合并症较少。 5.0% vs. 25%，p<0.001）、急性卒中（2.8% vs. 8.3%，p=0.05）、急性肾衰竭（5.7% vs. 13%，p=0.04）和灌注不良综合征（8.5% vs. . 26%，p<0.001），但心脏压塞更多（18% vs. 11%，p=0.03）。IMH 组的主动脉根部置换率较低（15% vs. 33%，p<0.001），2 区弓形置换率较低（9.4% vs. 18%，p=0.02），交叉钳夹时间较短（120 分钟 vs. 150 分钟， p<0.001）。IMH 组的手术死亡率显着较低（0.9% vs. 8.8%，p=0.005），多变量回归模型显示 IMH 具有保护性，优势比为 0.11，p=0.03。两组的 10 年生存率相似（65% vs. 61%，p=0.35）。IMH 术后中期死亡率的风险比为 0.73，p=0.12。

结论

急性 A 型 IMH 可以通过紧急开放主动脉修复术进行治疗，具有良好的短期和中期疗效。