Surgical Management Might Lower Mortality in Acute Type A Aortic Intramural Hematoma

The optimal management of type A intramural hematoma (IMH) is controversial, particularly in uncomplicated cases. This retrospective analysis assessed how different management approaches (physician-led surgical repair or conservative treatment, patient-led conservative treatment [patients who were recommended by the physician for surgery but selected conservative treatment], and physician-led conservative treatment [patients who were recommended by the physician for conservative treatment]) affect post-treatment mortality in patients with type A IMH. This retrospective study included 79 patients with acute type A IMH who underwent surgical management (n = 17), conservative treatment (n = 18), or patient preference for conservative treatment (n = 44). The analyses included patient demographics, clinical features, length of hospital stay, and post-treatment all-cause mortality. The multivariate Cox regression analysis revealed a trend toward a decreased risk of death with surgery over a median 4-year follow-up that was not significant (surgery versus conservative treatment: hazard ratio [HR] [95% CI] = 0.212 [0.025-1.351], P = 0.156). The risk of death was similar between the two conservative treatment approaches (patient-driven versus physician-driven treatment: HR [95% CI] = 0.915 [0.321-2.666], P = 0.885). The clinicodemographic factors of age (HR [95% CI] = 1.061 [1.006-1.119]), hypertension (HR [95% CI] = 11.747 [1.657-83.285]), hyperlipidemia (HR [95% CI] = 4.837 [1.212-19.314]), and heart disease (HR [95% CI] = 4.739 [1.408-15.873]) increased the risk of death (all P < 0.05). In conclusion, we encourage such patients to undergo early surgical treatment, although conservative treatment may still be a viable option for certain patients. Frequent follow-up with echocardiographic imaging is recommended for type A IMH after surgical or conservative treatment.