Abstract 755: Ten-year Survival in Patients with Type A Aortic Intramural Hematoma

Abstract

Recent studies have demonstrated that short and mid-term prognosis of type A acute aortic intramural hematoma (IMH) is remarkably better than classic aortic dissection (AD). The distinctive pathology of IMH from classic AD may account for such difference. However, it is uncertain if the prognosis of IMH remains favorable during long-term (ten-year) follow-up. The purpose of this study was to clarify the long-term prognosis of type A IMH. A total of 432 patients with acute aortic syndrome were admitted to our institution from 1989 to 2006. Of these patients, there were 42 patients with type A IMH and 201 patients with classic type A AD. In-hospital and long-term outcomes of the 42 patients with type A IMH were evaluated. Mean age of the patients was 66±10 at baseline and 25 patients were female. Mean follow-up period was 7.6 years. Emergent surgical repair was performed in 11 patients due to complication including cardiac tamponade, aortic regurgitation and aortic dilatation; while 31 patients were treated with initial medical therapy. Nine patients who demonstrated progression to AD or increase in size of hematoma underwent surgical repair except for 2 patients who refused surgery and died of aortic rupture. In-hospital mortality rate of all 42 IMH patients was 4%. There were 3 late deaths and the causes of death were pneumonia, renal failure, and heart failure. The actuarial survival rates were 95, 95 and 87% at 1, 5 and 10 years. Medical treatment alone was not enough to manage all type A IMH patients and almost a half of the patients needed surgical intervention. However, type A IMH patients who were treated medically with surgical repair in cases with complications have favorable long-term (ten-year) prognosis.