Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: A propensity score–matched analysis

Matsushita, Akihito; Fukui, Toshihiro; Tabata, Minoru; Sato, Yasunori; Takanashi, Shuichiro

doi:10.1016/j.jtcvs.2015.09.055

Cited by 37 publications

(39 citation statements)

References 22 publications

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“…Despite the present gaps in our knowledge of their natural history, popular management approach for ATAIMH, especially in the Western experience (IRAD, Stanford, and other North American authors), continues to be similar to that of ATAAD involving urgent aortic repair (3,(5)(6)(7). On the other hand, most studies from the Far East recommend initial medical management, with surgery reserved for specific circumstances complicating the course of otherwise stable ATAIMH patients and have reported acceptable early and late outcomes (8)(9)(10). Table 1 highlights some of the major differences in the literature reporting experience in management of ATAIMH from the Western vs. Eastern centers.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and management of type A intramural hematoma

Sandhu

Tanaka

Charlton-Ouw

et al. 2016

Ann. Cardiothorac. Surg.

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Background: Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. Western worlds.We examined the literature and our experience to report outcomes after repair of ATAIMH. Methods:We reviewed the hospital, follow-up clinic records and online mortality databases for all patients who presented to our center for open repair of ATAAD between 1999 and 2014. Preoperative characteristics, early and long-term outcomes were compared between classic ATAAD vs. ATAIMH. Survival was analyzed using Kaplan-Meier and log-rank statistics.Results: Of the 523 repaired ATAAD, 101 patients (19%) presented with IMH and 422 (81%) had classic dissection. ATAIMH were significantly older (64.8±12.9 vs. 56.8±14.6 years; P<0.001), more commonly females (39% vs. 26%; P=0.010), had poor baseline renal function (i.e., glomerular filtration rate) (P<0.017), more retrograde dissections (27% vs. 8.3%; P<0.001), and less distal malperfusion (5% vs. 15%; P<0.001).Age greater than 60 years, female sex, retrograde dissection, and Marfan syndrome were strongly correlated with ATAIMH. Time to repair for ATAIMH was longer (median, 55.3 vs. 9.8 hours; P<0.001) with one death in ATAIMH within three days of presentation (0.9% vs. 6%; P=0.040). In all, 30-day mortality in ATAIMH was not different from classic ATAAD (12% vs.16%; P=0.289). A significantly lower incidence of postoperative dialysis in ATAIMH was noted (10% vs. 19%; P=0.034). When adjusted for age and renal function, late survival was improved with IMH (P<0.039).Conclusions: ATAIMH continues to be associated with significant morbidity and mortality, comparable to classic aortic dissection. A multidisciplinary management approach involving aggressive medical management and risk stratification for timely surgical intervention, along with genetic profiling, is recommended for optimal care. Long-term monitoring is mandatory to assess compliance to medical therapy and recognition of evolving complications.

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Section: Introductionmentioning

confidence: 99%

Outcomes and management of type A intramural hematoma

Sandhu

Tanaka

Charlton-Ouw

et al. 2016

Ann. Cardiothorac. Surg.

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“…Overall, 5,133 unique records were identified from the literature search (Table 1). Following review, 15 were included in the quantitative analysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), with a total of 744 patients. Four were multi-center studies (7,15,17,20), including an international registry (7).…”

Section: Literature Searchmentioning

confidence: 99%

“…Four studies presented survival data for 342 patients undergoing urgent surgery (9,10,12,16). Pooled overall survival at 1-, 2-, 3-, 5-, and 10-year was 91.8%, 90.2%, 89.2%, 87.7%, and 71.1%, respectively (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

Surgery for type A intramural hematoma: a systematic review of clinical outcomes

Tian

Chakos

Hirst

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. The present systematic review aims to evaluate the mortality and morbidities following surgery for type A IMH. Methods: Electronic searches were performed on five databases from dates of inception to December 2018. All studies with surgical outcomes for type A intramural hematoma were identified by two independent researchers and relevant data extracted. Random-effects meta-analysis of proportions or meta-analysis of means were performed to aggregate the data. Survival data were pooled using reconstructed individual patient data derived from Kaplan-Meier curves. Results: Fifteen studies with 744 patients were identified. Ten studies were from Asian countries (73% of patients). Overall mortality was 8.2% [95% confidence interval (CI): 4.6-13.9%]. Mortality from Asian centers was 5.3% (95% CI: 3.6-7.7%) and 18.9% (95% CI: 7.0-40.4%) in Western centers. Postoperative complications were poorly reported and hence not analyzable. Overall pooled survival of 343 patients from four studies at 1-, 2-, 3-, 5-, and 10-year was 91.8%, 90.2%, 89.2%, 87.7%, and 71.1%, respectively. Conclusions: There is an acceptable level of risk of death after surgery for type A IMH, though significant variations exist between results from Asian and Western centers. More detailed studies are required to clarify the controversies surrounding management of type A IMH.

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“…On the other hand, several patients died suddenly during conservative treatment. Matsushita et al (4) highlighted that patients with type A IMH might be different patients from those with aortic dissection, with different preoperative clinical characteristics. Thus, IMH patients were older, included a higher ratio of female patients and more frequently had hypertension, hyperlipidemia and cardiac tamponade.…”

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confidence: 99%

Current trends in aortic intramural hematoma management—a shift from conservative to a more aggressive treatment

Σπανός

Kölbel²,

Giannoukas

2019

Ann. Cardiothorac. Surg.

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Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: A propensity score–matched analysis

Abstract: Patients with intramural hematoma have different preoperative clinical characteristics compared with patients with aortic dissection. Emergency open surgery for type A intramural hematoma demonstrated low operative mortality and excellent 5-year survival.

Cited by 37 publications

References 22 publications

Outcomes and management of type A intramural hematoma

Outcomes and management of type A intramural hematoma

Surgery for type A intramural hematoma: a systematic review of clinical outcomes

Current trends in aortic intramural hematoma management—a shift from conservative to a more aggressive treatment

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