Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma.
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.
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.
Anthony L
AL
Estrera
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Harleen K
HK
Sandhu
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Samuel S
SS
Leake
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Kristofer M
KM
Charlton-Ouw
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Rana O
RO
Afifi
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Charles C
CC
Miller
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston, and Memorial Hermann Hospital, Houston, Tex.
Hazim J
HJ
Safi