Abstract
Objective
This single-center retrospective study evaluated early and midterm outcomes of 100 consecutive patients with type A intramural hematoma.
Methods
Initial watch-and-wait strategy was indicated if the maximum aortic diameter was < 50 mm, pain score was < 3/10 on the numerical rating scale, and no ulcer-like projection was observed in the ascending aorta. The primary endpoints of this study were all-cause and aorta-related deaths, and the secondary endpoint was aortic events.
Results
Initial watch-and-wait strategy was indicated in 52 patients. Emergency aortic repair was indicated in the remaining 48 patients; 2, 31, and 15 patients died before surgery, underwent emergency surgery, and declined emergency surgery, respectively. Among the watch-and-wait group, 11 (21%) patients underwent aortic repair during hospitalization. In-hospital mortality rates, 5-year survival rates, and 5-year freedom from aorta-related death were not significantly different between the initial watch-and-wait strategy and emergency surgery (2% vs. 6%, 92% vs. 82%, and 100% vs. 94%, respectively). In the initial watch-and-wait strategy group, 5-year freedom from aortic events and freedom from aortic events involving the ascending aorta were 60% and 66%, respectively.
Conclusions
The early and midterm outcomes with the initial watch-and-wait strategy in patients with type A intramural hematoma with a maximum aortic diameter of ≤ 50 mm, pain score of ≤ 3/10, and no ulcer-like projection in the ascending aorta were favorable with no aorta-related death.
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Supplementary file1 Supplemental Video 1. Intraoperative video of cases with acute type A aortic dissection and IMH complicated by cardiac tamponade without aortic rupture (MP4 37336 KB)
Supplementary file2 Supplemental Video 2. Intraoperative video of a patient with type A IMH with a ULP in the ascending aorta who developed massive bleeding from the ascending aorta following heparin administration (MP4 47527 KB)
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Kitamura, T., Fukuzumi, M., Mishima, T. et al. Watch-and-wait strategy for selected patients with type A intramural hematoma. Gen Thorac Cardiovasc Surg 72, 225–231 (2024). https://doi.org/10.1007/s11748-023-01967-y
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DOI: https://doi.org/10.1007/s11748-023-01967-y