Clinical outcomes of medical therapy and timely operation in initially diagnosed type a aortic intramural hematoma: a 20-year experience.
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.


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.
Kitai
Takeshi
T
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan.
Kaji
Shuichiro
S
Yamamuro
Atsushi
A
Tani
Tomoko
T
Tamita
Koichi
K
Kinoshita
Makoto
M
Ehara
Natsuhiko
N
Kobori
Atsushi
A
Nasu
Michihiro
M
Okada
Yukikatsu
Y
Furukawa
Yutaka
Y
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology; D001014:Aortic Aneurysm / Q000209:etiology; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies