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[Comparison of outcomes between emergency surgery and conservative treatment for acute type A aortic intramural

J Y Song¹, J L Wu¹, J Liu²

¹Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510100, China.

Zhonghua Yi Xue Za Zhi

|January 26, 2026

Objective: To compare the clinical outcomes of emergency surgery and conservative treatment in patients with acute type A aortic intramural hematoma (IMH). Methods: Patients with acute type A aortic IMH who were diagnosed atthe Department of Cardiovascular Surgery of Guangdong Provincial People's Hospital between November 2011 and February 2023 were retrospectively enrolled. According to international guideline criteria, patients were divided into theemergencysurgery group (surgery group) and theconservative treatment group (conservative group). Baseline characteristics, in-hospital mortality, and 5-year survival after discharge were compared between the two groups. Results: A total of 224 patients with acute type A aortic IMH were included. There were 138 (61.6%) and 86 (38.4%)patients underwent emergent surgery andconservative treatment, respectively. There were no significant differences between the two groups in age, sex, height, weight, diabetes mellitus, dyslipidemia, renal insufficiency, history of cardiovascular disease, moderate to severe aortic regurgitation, or moderate to large pericardial effusion (all P>0.05). The proportions of hypertension [81.9% (113/138) vs 66.3% (57/86)] and coronary artery disease [37.0% (51/138) vs 18.6% (16/86)] were higher in the surgery group than those in the conservative group, whereas the proportions of chronic obstructive pulmonary disease [14.5% (20/138) vs 29.1% (25/86)], smoking history [18.1% (25/138) vs 40.7% (35/86)], Marfan syndrome [1.4% (2/138) vs 8.1% (7/86)], and bicuspid aortic valve [2.2% (3/138) vs 9.3% (8/86)] were lower in the surgery group than those in the conservative group (all P<0.05). Regarding imaging features, the prevalence of ulcer-like projection (ULP) was higher in the surgery group than that in the conservative group [44.9% (62/138) vs 29.1% (25/86), P=0.024]. In addition, ascending aortic length [12.1 (11.6, 13.4) cm vs 9.4 (8.7, 11.7) cm], maximal aortic diameter [44.8 (40.4, 50.0) mm vs 41.7 (37.5, 46.0) mm], and hematoma thickness [13.7 (11.0, 17.6) mm vs 8.0 (6.0, 9.6) mm] were all greater in the surgery group than those in the conservative group (all P<0.001). In-hospital mortality [14.0% (12/86) vs 15.9% (22/138)] and 5-year survival rate [90.1% (95%CI: 83.7%-96.9%) vs 83.5% (95%CI: 77.4%-90.1%)] did not differ significantly between the two groups (both P>0.05). Conclusions: The study indicates that patients in the emergency surgery group had more high-risk imaging features compared with the conservative treatment group. This suggests that for patients with acute type A aortic IMH who are clinically and radiographically stable and strictly selected, conservative treatment can achieve survival outcomes similar to surgery in the mid-term follow-up..

Objective: To compare the clinical outcomes of emergency surgery and conservative treatment in patients with acute type A aortic intramural hematoma (IMH). Methods: Patients with acute type A aortic IMH who were diagnosed atthe Department of Cardiovascular Surgery of Guangdong Provincial People's Hospital between November 2011 and February 2023 were retrospectively enrolled. According to international guideline criteria, patients were divided into theemergencysurgery group (surgery group) and theconservative treatment group (conservative group). Baseline characteristics, in-hospital mortality, and 5-year survival after discharge were compared between the two groups. Results: A total of 224 patients with acute type A aortic IMH were included. There were 138 (61.6%) and 86 (38.4%)patients underwent emergent surgery andconservative treatment, respectively. There were no significant differences between the two groups in age, sex, height, weight, diabetes mellitus, dyslipidemia, renal insufficiency, history of cardiovascular disease, moderate to severe aortic regurgitation, or moderate to large pericardial effusion (all P>0.05). The proportions of hypertension [81.9% (113/138) vs 66.3% (57/86)] and coronary artery disease [37.0% (51/138) vs 18.6% (16/86)] were higher in the surgery group than those in the conservative group, whereas the proportions of chronic obstructive pulmonary disease [14.5% (20/138) vs 29.1% (25/86)], smoking history [18.1% (25/138) vs 40.7% (35/86)], Marfan syndrome [1.4% (2/138) vs 8.1% (7/86)], and bicuspid aortic valve [2.2% (3/138) vs 9.3% (8/86)] were lower in the surgery group than those in the conservative group (all P<0.05). Regarding imaging features, the prevalence of ulcer-like projection (ULP) was higher in the surgery group than that in the conservative group [44.9% (62/138) vs 29.1% (25/86), P=0.024]. In addition, ascending aortic length [12.1 (11.6, 13.4) cm vs 9.4 (8.7, 11.7) cm], maximal aortic diameter [44.8 (40.4, 50.0) mm vs 41.7 (37.5, 46.0) mm], and hematoma thickness [13.7 (11.0, 17.6) mm vs 8.0 (6.0, 9.6) mm] were all greater in the surgery group than those in the conservative group (all P<0.001). In-hospital mortality [14.0% (12/86) vs 15.9% (22/138)] and 5-year survival rate [90.1% (95%CI: 83.7%-96.9%) vs 83.5% (95%CI: 77.4%-90.1%)] did not differ significantly between the two groups (both P>0.05). Conclusions: The study indicates that patients in the emergency surgery group had more high-risk imaging features compared with the conservative treatment group. This suggests that for patients with acute type A aortic IMH who are clinically and radiographically stable and strictly selected, conservative treatment can achieve survival outcomes similar to surgery in the mid-term follow-up..

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