Management of acute type A intramural hematoma: Upfront surgery or individualized approach? A retrospective analysis and meta-analysis

Simon C.Y. Chow, Randolph H.L. Wong, Ishan Lakhani, Michelle V. Wong, Gary Tse, Peter S.Y. Yu, Jacky Y.K. Ho, Takuya Fujikawa, Malcolm J. Underwood

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

Background: Management of acute type A intramural hematoma (IMH) is a controversial topic. In our study, we aim to analyze the survival outcomes in local patients with acute type A IMH and a meta-analysis on survival in type A IMH treated medically versus surgically was performed. Methods: From 2014 to 2019, 65 patients with acute type A IMH were selected for analysis. Primary outcome of interest was 1 year all cause survival. The rate of aortic-related events in the medical group was evaluated. PubMed and Embase were searched for meta-analysis. Results: The mean age of our cohort was 61.7±9.7 years. Of the 65 patients, 40% had emergency operation. Overall 1-year survival was 96.9%. The 1-year survival was 94.9% for the medical group. 46.2% of the medical group required aortic intervention at a mean duration of 191±168 days. Maximal aortic diameter (MAD) ≥45 mm was predictive of aortic-related events in the medical group (OR: 7.0; 95% CI, 1.7–29.4; P=0.008). For the meta-analysis, 21 studies were identified, and 900 patients were included. Emergent surgery was associated with improved survival in type A IMH (OR: 0.76; 95% CI, 0.29–1.97, P=0.58; I2=27%). Conclusions: The 1-year survival after type A IMH was promising, regardless of approach. The conservative-first approach was found to be safe & feasible, and upfront surgery remained the management of choice in general. Patients with MAD ≥45 mm was associated with subsequent aortic intervention in the medical-first group.

Original languageEnglish
Pages (from-to)680-689
Number of pages10
JournalJournal of Thoracic Disease
Volume12
Issue number3
DOIs
Publication statusPublished - 1 Mar 2020
Externally publishedYes

Keywords

  • Acute aortic dissection
  • Aorta
  • Ascending aorta
  • Medical therapy
  • Surgery

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