title: Early and late outcomes of acute type A aortic dissection with intramural hematoma.
abstract: BACKGROUND
  Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH.
  
  
  METHODS
  We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH.
  
  
  RESULTS
  Between 2000 and 2013, we performed 418 repairs for acute type A aortic dissection. These were divided into 2 groups of patients: 64 patients (15%) with type A IMH and 354 patients (85%) with typical dissection. Those with IMH were older (62.4 ± 13.9 years vs 56.7 ± 14.7 years; P < .0046) and presented with reduced renal function (ie, glomerular filtration rate) (P < .0341), less frequently with distal malperfusion, and less frequently with rupture (P < .0116). With IMH, the time from presentation to repair was, by strategy, longer (median, 67 vs 6 hours; P < .0001), but no mortality occurred within 3 days of presentation. Mortality with IMH did not differ from typical dissection: 7 out of 64 patients (10.9%) versus 52 out of 354 patients (14.7%; P = .4276). A lower incidence of postoperative dialysis in the IMH group approached significance: 6 out of 63 patients (9.5%) versus 64 out of 347 patients (18.4%; P = .0820). When adjusted for age and renal function, late survival was improved with IMH (P < .0343).
  
  
  CONCLUSIONS
  Repair of acute type A aortic dissection with IMH is associated with significant early morbidity and mortality, differing minimally from typical aortic dissection. Although expectant repair within 3 days may be applied, the purposeful delay imparted little advantage. Improved late outcomes may be seen with IMH, but continued long-term surveillance is required for verification.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex. Electronic address: Anthony.L.Estrera@uth.tmc.edu.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Sandhu
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Leake
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Kristofer M
authors.initials: KM
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Rana O
authors.initials: RO
authors.lastname: Afifi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome