Stepwise external wrapping procedure for type A intramural hematoma.

Abstract

The optimal treatment for Stanford type A acute intramural hematoma remains controversial, especially in elderly or high-risk patients. We have developed a new surgical approach using artificial grafts (stepwise external wrapping) for high-risk patients. The aim of this study is to report our results using the stepwise external wrapping procedure in the treatment of high-risk patients with type A intramural hematoma. Among the 129 patients admitted for type A intramural hematoma between January 2016 and January 2020, 49 patients underwent stepwise external wrapping. The mean patient age was 78±7years. The new standard European system for cardiac operative risk evaluation II was 54%±23%. The mean overall operation and cardiopulmonary bypass times were 96±13minutes and 35±10minutes, respectively. There were no hospital deaths. Two cases of temporary neurologic disorder, 1 case of renal failure, and 2 cases of wound infection occurred during the postoperative period. The intensive care unit and hospital stays were 2±1days and 10±3days, respectively. The thickness of intramural hematoma that had been the target of the stepwise external wrapping procedure decreased significantly from 18.0±10.7mm preoperatively to 5.2±4.4mm at 3months after surgery (P<.05). The follow-up survival was 97.7%±4.4 % at 1year after surgery and 89.8%±11.4% at 3years after surgery. There was no aortic-related death during follow-up. Our stepwise external wrapping is a feasible alternative to conventional graft replacement for high-risk patients with type A intramural hematoma. The early and midterm outcomes of the procedure were satisfactory, but further careful follow-up is needed.