Management of acute type A intramural hematoma : upfront surgery or individualized approach? A retrospective analysis and meta-analysis
2020 Journal of Thoracic Disease. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Journal of thoracic disease - 12(2020), 3 vom: 21. März, Seite 680-689 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chow, Simon C Y [VerfasserIn] |
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| Links: |
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| Themen: |
Acute aortic dissection |
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| Anmerkungen: |
Date Revised 17.08.2022 published: Print Citation Status PubMed-not-MEDLINE |
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| doi: |
10.21037/jtd.2019.12.109 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM308592778 |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a 2020 Journal of Thoracic Disease. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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%) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a acute aortic dissection | |
| 650 | 4 | |a ascending aorta | |
| 650 | 4 | |a medical therapy | |
| 650 | 4 | |a surgery | |
| 700 | 1 | |a Wong, Randolph H L |e verfasserin |4 aut | |
| 700 | 1 | |a Lakhani, Ishan |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Michelle V |e verfasserin |4 aut | |
| 700 | 1 | |a Tse, Gary |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Peter S Y |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Jacky Y K |e verfasserin |4 aut | |
| 700 | 1 | |a Fujikawa, Takuya |e verfasserin |4 aut | |
| 700 | 1 | |a Underwood, Malcolm J |e verfasserin |4 aut | |
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