Operative and hemostatic differences between acute type A intramural hematoma and aortic dissection

Although acute type A intramural hematoma and classic aortic dissection often present with similar clinical features and are managed with similar operative strategies, their perioperative risk profiles may differ. Whether these differences translate into distinct surgical outcomes remains incompletely understood.

This retrospective single-center study included 351 patients who underwent open surgical repair for acute type A intramural hematoma or aortic dissection between February 2018 and December 2022, with follow-up through November 2023. Baseline characteristics, operative variables, perioperative transfusion requirements, and early and midterm outcomes were compared. Inverse probability of treatment weighting was used to adjust for baseline differences between groups.

Among the cohort, 31 patients had intramural hematoma and 320 had aortic dissection. Compared with aortic dissection, intramural hematoma patients were older and more frequently had distal aortic involvement and pericardial effusion. Operative times, including cardiopulmonary bypass and circulatory arrest durations, were significantly shorter in the intramural hematoma group. After inverse probability of treatment weighting adjustment, intramural hematoma was associated with lower in-hospital mortality (odds ratio, 0.15; 95% confidence interval, 0.07-0.33), 30-day mortality (odds ratio, 0.20; 95% confidence interval, 0.09-0.43), and midterm mortality (hazard ratio, 0.15; 95% confidence interval, 0.07-0.32). No patient in the intramural hematoma group required open surgical reintervention during follow-up.

Despite similar clinical presentations, acute type A intramural hematoma and aortic dissection differ in their clinical courses. Patients with intramural hematoma experienced shorter operative times and superior early and midterm survival without open reintervention, supporting the concept that these 2 entities follow distinct perioperative and postoperative courses.