Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, Guangdong, China.
Department of Cardiovascular Surgery, Guangzhou First People' Hospital, Guangzhou, China.
BMC Cardiovasc Disord. 2021 Jun 10;21(1):286. doi: 10.1186/s12872-021-02104-4.
The proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease.
From January 2015 to December 2018, 124 consecutive patients were diagnosed with an acute type A aortic IMH and were included in this study. According to our surgical indications, they were divided into two groups: an operation group (OG) and a conservative treatment group (CG).
Of 124 patients, 83 (66.9%) patients accepted emergency surgery and 41 (33.1%) patients accepted strict conservative treatment. There were no differences between these two groups in early mortality and complications. However, the late mortality of patients in the CG was significantly higher than for patients in the OG. A maximum aortic diameter in the ascending aorta and aortic arch ≥ 45 mm and maximum thickness of IMH in the same section ≥ 8 mm were risk factors for IMH related death in patients undergoing conservative treatment.
The mortality associated with emergency surgery for patients with acute type A aortic IMH was satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than medical treatment for patients with acute type A aortic IMH.
急性 A 型主动脉壁内血肿（IMH）的恰当治疗管理仍存在争议。本研究旨在比较该病患者接受急诊手术或保守治疗的结局。
2015 年 1 月至 2018 年 12 月，连续纳入 124 例急性 A 型主动脉 IMH 患者，根据手术指征将其分为手术组（OG）和保守治疗组（CG）。
124 例患者中，83 例（66.9%）接受急诊手术，41 例（33.1%）接受严格保守治疗。两组患者的早期死亡率和并发症无差异，但 CG 组的晚期死亡率明显高于 OG 组。主动脉升部和主动脉弓最大直径≥45mm，同一节段 IMH 最大厚度≥8mm 是保守治疗患者与 IMH 相关死亡的危险因素。
急性 A 型主动脉 IMH 患者接受急诊手术的死亡率令人满意。在具有成熟手术技术和术后管理的临床中心，与药物治疗相比，急诊手术治疗可为急性 A 型主动脉 IMH 患者提供更好的结局。
