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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Outcome After Surgery for Type A Intramural Hematoma.

Fausto Biancari1, Angelo M Dell'Aquila2, Timo Mäkikallio1

  • 1Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland.

Journal of Cardiovascular Development and Disease
|June 25, 2026
PubMed
Summary

Surgically treated type A intramural hematoma (TAIMH) shows similar early and late outcomes to typical type A aortic dissection (TAAD). Despite a different risk profile, TAIMH prognosis is comparable to TAAD after surgical intervention.

Keywords:
aortic dissectionintramural hematomatype aortic dissection

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Aortic Dissection and Hematoma

Background:

  • The clinical characteristics and prognosis of type A intramural hematoma (TAIMH) remain incompletely understood.
  • TAIMH is an emergency condition requiring surgical intervention, but its outcomes compared to typical type A aortic dissection (TAAD) are not well-established.

Purpose of the Study:

  • To evaluate and compare the early and late outcomes of surgically treated TAIMH versus TAAD.
  • To assess the prevalence and risk profile differences between TAIMH and TAAD patients undergoing surgery.

Main Methods:

  • Analysis of consecutive patients from the ERTAAD registry who underwent surgery for TAAD or TAIMH across 18 European cardiac surgery centers.
  • Comparison of early (in-hospital mortality) and late (10-year survival, reoperation rates) outcomes between TAIMH and TAAD groups.
  • Propensity-score matching was employed to adjust for baseline and operative variables, comparing 386 TAIMH patients with 386 TAAD patients.

Main Results:

  • TAIMH constituted 9.9% of surgically treated patients (386/3902) and exhibited a different risk profile based on Penn classification compared to TAAD.
  • Propensity-score matching revealed no significant differences in early or late outcomes between TAIMH and TAAD groups, including in-hospital mortality (13.5% vs. 16.3%) and 10-year mortality (51.3% vs. 51.6%).
  • Ten-year cumulative incidence rates for proximal and distal aortic reoperations were similar between TAIMH and TAAD patients (4.2% vs. 3.3% and 12.6% vs. 7.6%, respectively).

Conclusions:

  • Surgically treated TAIMH is relatively uncommon, presenting with distinct risk factors but comparable early and late outcomes to TAAD when adjusted for confounding variables.
  • Despite surgical intervention, TAIMH survivors exhibit low relative survival rates compared to the general population, indicating poor postoperative outcomes similar to TAAD.
  • Larger studies are required to confirm these findings, which are limited to surgically treated TAIMH and do not address conservatively managed cases.