title: Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: A propensity score-matched analysis.
abstract: OBJECTIVE
  We aimed to evaluate the preoperative characteristics and surgical outcomes of acute type A intramural hematoma.
  
  
  METHODS
  Between January 2000 and June 2011, 460 consecutive patients underwent emergency open surgery for type A acute aortic syndrome at Sakakibara Heart Institute. Among these patients, 121 had intramural hematoma and 339 had typical aortic dissection. We compared the clinical characteristics and surgical outcomes using propensity score matching.
  
  
  RESULTS
  In all patients, the intramural hematoma group had an older age (69.2 ± 10.4 years vs 63.4 ± 13.5 years; P < .001), included a higher ratio of female patients (56.2% vs 44.0%, P = .020), and more frequently had hypertension (94.2% vs 83.5%, P = .005), hyperlipidemia (25.6% vs 12.7%, P < .001), and cardiac tamponade (33.1% vs 18.3%, P < .001) than patients with aortic dissection. Cerebral malperfusion (0.8% vs 5.3%, P = .033), myocardial malperfusion (0.8% vs 8.2%, P = .002), lower limb malperfusion (1.7% vs 7.9%, P = .015), Marfan syndrome (0% vs 3.5%, P = .042), and aortic valve insufficiency (2.5% vs 15.0%, P < .001) were less frequently observed in the intramural hematoma group than in the aortic dissection group. After propensity score matching, 116 matched pairs were created. In the matched analysis, operative mortality was 0.9% in the intramural hematoma group (1/116) and 3.4% in the aortic dissection group (4/116, P = .179). The intramural hematoma group demonstrated higher actuarial 1- and 5-year survivals than the aortic dissection group (99.1 % vs 93.6% and 97.3% vs 85.9%, respectively, P = .006). In the multivariate analysis, intramural hematoma was shown to be associated with lower midterm mortality (hazard ratio, 0.316; 95% confidence interval, 0.102-0.974; P = .045).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, Chiba Medical Center, Chiba, Japan; Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: matsushita@seikeikai-cmc.jp.
authors.forename: Akihito
authors.initials: A
authors.lastname: Matsushita
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.affiliation: The Clinical Research Center, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic dissection; intramural hematoma; surgery