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Original Articles: Cardiovascular

Intermediate-Term Results of Surgical Treatment of Acute Intramural Hematoma Involving the Ascending Aorta

^a Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
^b Department of Thoracic and Cardiovascular Surgery, Saga University, Saga, Japan

Accepted for publication November 13, 2007.

^_* Address correspondence to Dr Shimokawa, Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu City, Tokyo, 183-0003, Japan (Email: tshimokawa-circ{at}umin.ac.jp).

Background: The treatment strategy of acute intramural hematoma involving the ascending aorta remains uncertain. The objective of this study was to evaluate the effectiveness of surgical treatment for this condition.

Methods: A total of 41 patients underwent operation for acute intramural hematoma involving the ascending aorta between 2000 and 2006. Mean age was 67.2 ± 10.1 years, with 26 female patients and 10 in cardiogenic shock at presentation. Early and midterm results, including mortality, morbidity, survival, event-free rates, and the persistence of residual hematoma, were analyzed retrospectively in all patients. Mean follow-up period was 29.7 ± 18.1 months.

Results: All but one patient underwent operation within 72 hours from the onset of symptoms. Thirty-four patients underwent isolated ascending aortic replacement, three had hemiarch repair, and four required total arch replacement. There were no in-hospital deaths. Stroke occurred in two patients and transient neurologic dysfunction in one. Postoperative computed tomographic scan showed residual distal hematoma progression to classical double-barrel dissection in two patients. At five years follow-up, survival was 100%. During the follow-up period, one patient had a new type B aortic dissection. A follow-up study confirmed hematoma resorption in 29 patients (70.7%). The estimated freedom from intramural hematoma-related events was 92.6 ± 4.1% at five years. No independent predictor of intramural hematoma-related events was found on multivariate analysis.

Conclusions: Immediate surgical treatment of acute aortic intramural hematoma involving the ascending aorta with open distal replacement of ascending aorta results in lower mortality rates and excellent midterm survival.