Outcome After Surgery for Type A Intramural Hematoma

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.