Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta

A propensity score-matched analysis

Akihito Matsushita, Toshihiro Fukui, Minoru Tabata, Yasunori Sato, Shuichiro Takanashi

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective We aimed to evaluate the preoperative characteristics and surgical outcomes of acute type A intramural hematoma. Methods Between January 2000 and June 2011, 460 consecutive patients underwent emergency open surgery for type A acute aortic syndrome at Sakakibara Heart Institute. Among these patients, 121 had intramural hematoma and 339 had typical aortic dissection. We compared the clinical characteristics and surgical outcomes using propensity score matching. Results In all patients, the intramural hematoma group had an older age (69.2 ± 10.4 years vs 63.4 ± 13.5 years; P <.001), included a higher ratio of female patients (56.2% vs 44.0%, P =.020), and more frequently had hypertension (94.2% vs 83.5%, P =.005), hyperlipidemia (25.6% vs 12.7%, P <.001), and cardiac tamponade (33.1% vs 18.3%, P <.001) than patients with aortic dissection. Cerebral malperfusion (0.8% vs 5.3%, P =.033), myocardial malperfusion (0.8% vs 8.2%, P =.002), lower limb malperfusion (1.7% vs 7.9%, P =.015), Marfan syndrome (0% vs 3.5%, P =.042), and aortic valve insufficiency (2.5% vs 15.0%, P <.001) were less frequently observed in the intramural hematoma group than in the aortic dissection group. After propensity score matching, 116 matched pairs were created. In the matched analysis, operative mortality was 0.9% in the intramural hematoma group (1/116) and 3.4% in the aortic dissection group (4/116, P =.179). The intramural hematoma group demonstrated higher actuarial 1- and 5-year survivals than the aortic dissection group (99.1 % vs 93.6% and 97.3% vs 85.9%, respectively, P =.006). In the multivariate analysis, intramural hematoma was shown to be associated with lower midterm mortality (hazard ratio, 0.316; 95% confidence interval, 0.102-0.974; P =.045). Conclusions Patients with intramural hematoma have different preoperative clinical characteristics compared with patients with aortic dissection. Emergency open surgery for type A intramural hematoma demonstrated low operative mortality and excellent 5-year survival.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number2
DOIs
Publication statusPublished - 2016 Feb 1
Externally publishedYes

Fingerprint

Propensity Score
Hematoma
Aorta
Dissection
Mortality
Emergencies
Marfan Syndrome
Cardiac Tamponade
Survival
Aortic Valve Insufficiency
Hyperlipidemias
Lower Extremity
Multivariate Analysis
Confidence Intervals
Hypertension

Keywords

  • Aortic dissection
  • intramural hematoma
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta : A propensity score-matched analysis. / Matsushita, Akihito; Fukui, Toshihiro; Tabata, Minoru; Sato, Yasunori; Takanashi, Shuichiro.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 151, No. 2, 01.02.2016, p. 351-358.

Research output: Contribution to journalArticle

Matsushita, Akihito ; Fukui, Toshihiro ; Tabata, Minoru ; Sato, Yasunori ; Takanashi, Shuichiro. / Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta : A propensity score-matched analysis. In: Journal of Thoracic and Cardiovascular Surgery. 2016 ; Vol. 151, No. 2. pp. 351-358.
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N2 - Objective We aimed to evaluate the preoperative characteristics and surgical outcomes of acute type A intramural hematoma. Methods Between January 2000 and June 2011, 460 consecutive patients underwent emergency open surgery for type A acute aortic syndrome at Sakakibara Heart Institute. Among these patients, 121 had intramural hematoma and 339 had typical aortic dissection. We compared the clinical characteristics and surgical outcomes using propensity score matching. Results In all patients, the intramural hematoma group had an older age (69.2 ± 10.4 years vs 63.4 ± 13.5 years; P <.001), included a higher ratio of female patients (56.2% vs 44.0%, P =.020), and more frequently had hypertension (94.2% vs 83.5%, P =.005), hyperlipidemia (25.6% vs 12.7%, P <.001), and cardiac tamponade (33.1% vs 18.3%, P <.001) than patients with aortic dissection. Cerebral malperfusion (0.8% vs 5.3%, P =.033), myocardial malperfusion (0.8% vs 8.2%, P =.002), lower limb malperfusion (1.7% vs 7.9%, P =.015), Marfan syndrome (0% vs 3.5%, P =.042), and aortic valve insufficiency (2.5% vs 15.0%, P <.001) were less frequently observed in the intramural hematoma group than in the aortic dissection group. After propensity score matching, 116 matched pairs were created. In the matched analysis, operative mortality was 0.9% in the intramural hematoma group (1/116) and 3.4% in the aortic dissection group (4/116, P =.179). The intramural hematoma group demonstrated higher actuarial 1- and 5-year survivals than the aortic dissection group (99.1 % vs 93.6% and 97.3% vs 85.9%, respectively, P =.006). In the multivariate analysis, intramural hematoma was shown to be associated with lower midterm mortality (hazard ratio, 0.316; 95% confidence interval, 0.102-0.974; P =.045). Conclusions Patients with intramural hematoma have different preoperative clinical characteristics compared with patients with aortic dissection. Emergency open surgery for type A intramural hematoma demonstrated low operative mortality and excellent 5-year survival.

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