Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma

1Citations
Citations of this article
30Readers
Mendeley users who have this article in their library.

Abstract

Introduction Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH. Methods We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH. Results Between 2000 and 2013, we performed 418 repairs for acute type A aortic dissection. These were divided into 2 groups of patients: 64 patients (15%) with type A IMH and 354 patients (85%) with typical dissection. Those with IMH were older (62.4 ± 13.9 years vs 56.7 ± 14.7 years; P <.0046) and presented with reduced renal function (ie, glomerular filtration rate) (P <.0341), less frequently with distal malperfusion, and less frequently with rupture (P <.0116). With IMH, the time from presentation to repair was, by strategy, longer (median, 67 vs 6 hours; P <.0001), but no mortality occurred within 3 days of presentation. Mortality with IMH did not differ from typical dissection: 7 out of 64 patients (10.9%) versus 52 out of 354 patients (14.7%; P =.4276). A lower incidence of postoperative dialysis in the IMH group approached significance: 6 out of 63 patients (9.5%) versus 64 out of 347 patients (18.4%; P =.0820). When adjusted for age and renal function, late survival was improved with IMH (P <.0343). Conclusions Repair of acute type A aortic dissection with IMH is associated with significant early morbidity and mortality, differing minimally from typical aortic dissection. Although expectant repair within 3 days may be applied, the purposeful delay imparted little advantage. Improved late outcomes may be seen with IMH, but continued long-term surveillance is required for verification.

Cite

CITATION STYLE

APA

Estrera, A. L., Sandhu, H. K., Leake, S. S., Charlton-Ouw, K. M., Afifi, R. O., Miller, C. C., & Safi, H. J. (2015). Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma. Journal of Thoracic and Cardiovascular Surgery, 149(2), S110–S115. https://doi.org/10.1016/j.jtcvs.2014.12.036

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free