Type A intramural hematoma over 21 years: A single center's experience

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Acute aortic syndromes, including intramural hematoma in type A distribution (TAIMH) and acute type A aortic dissection (ATAAD), require careful treatment evaluation.
• Historically, treatment strategies for TAIMH have varied, with ongoing debate regarding the optimal approach, particularly emergent surgery.

Purpose of the Study:

• To compare short- and mid-term outcomes between TAIMH and ATAAD patients treated at a single institution.
• To assess the viability of an emergent surgical treatment strategy for TAIMH.

Main Methods:

• Retrospective analysis of 903 patients with acute aortic syndrome (2000-2020).
• Comparison of baseline characteristics, operative details, and outcomes between TAIMH and ATAAD cohorts.
• Utilized cardinality and fine balance matching to control for confounding variables.

Main Results:

• Short-term postoperative outcomes were similar between surgically treated TAIMH and ATAAD patients.
• No significant difference in unadjusted long-term survival or reoperation rates.
• Matched analysis showed better mid-term survival for TAIMH patients, with no significant difference in stroke rates when controlling for cannulation strategy.

Conclusions:

• Surgical management of acute TAIMH yields excellent postoperative results.
• An aggressive, emergent operative strategy for TAIMH is supported in experienced aortic centers.
• TAIMH surgical outcomes are comparable to ATAAD, supporting its consideration as a viable treatment option.