TY - JOUR
T1 - Outcome After Surgery for Type A Intramural Hematoma
AU - Biancari, Fausto
AU - Dell’Aquila, Angelo M.
AU - Mäkikallio, Timo
AU - Gatti, Giuseppe
AU - Onorati, Francesco
AU - Perrotti, Andréa
AU - Rosato, Stefano
AU - D’Errigo, Paola
AU - Pettinari, Matteo
AU - Peterss, Sven
AU - Buech, Joscha
AU - Juvonen, Tatu
AU - Mustonen, Caius
AU - Demal, Till J.
AU - Pol, Marek
AU - Kacer, Petr
AU - Wisniewski, Konrad
AU - Vendramin, Igor
AU - Piani, Daniela
AU - Rinaldi, Mauro
AU - Ferrante, Luisa
AU - Quintana, Eduard
AU - Pruna‐Guillen, Robert
AU - Fiore, Antonio
AU - Mariscalco, Giovanni
AU - Acharya, Metesh
AU - Field, Mark
AU - Kuduvalli, Manoj
AU - Nappi, Francesco
AU - Gerelli, Sébastien
AU - Di Perna, Dario
AU - Rodriguez-Lega, Javier
AU - Conradi, Lenard
PY - 2026/6/3
Y1 - 2026/6/3
N2 - Background: The nature and prognosis of type A intramural hematoma (TAIMH) are not well established. In this study, we evaluated the early and late outcome after surgery for this emergency condition. Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) or TAIMH at 18 European centers for cardiac surgery. In this study, we compared the early and late outcomes of TAIMH and typical TAAD. Results: In total, 3902 consecutive patients were included in the ERTAAD registry, and 386 (9.9%) patients had TAIMH. Penn class a was present in 43.1% TAAD patients and in 34.5% TAIMH patients (p < 0.001). Among 3-month survivors, 10-year relative survival was 0.80 (95%CI 0.77–0.84) in TAAD patients and 0.76 (95%CI 0.63–0.88) in TAIMH patients. Propensity-score matching yielded 386 pairs of patients, and no significant difference was observed between the study groups in terms of early and late outcomes. In-hospital mortality rates were comparable (TAIMH 13.5% vs. TAAD 16.3%, p = 0.266). Ten-year mortality was 51.3% among TAIMH patients and 51.6% among TAAD patients (p = 0.274). TAIMH and TAAD had similar 10-year cumulative incidence rates of proximal (4.2% vs. 3.3%, p = 0.738) and distal aortic reoperations (12.6% vs. 7.6%, p = 0.779). Conclusions: This cohort study showed that the prevalence of patients with TAIMH requiring surgery is low and their risk profile is significantly different as shown by the Penn classification. The early and late outcomes of the study groups were not statistically different compared to typical TAAD when adjusted for baseline and operative variables. The relative survivals of 90-day TAIMH and TAAD survivors were low compared to the matched general population, indicating that surgically treated TAIMH demonstrated postoperative outcomes are poor and comparable to surgically treated TAAD after adjustment. Post-hoc power analysis suggested that much larger studies are needed to confirm these findings. These results are limited to TAIMH patients who underwent surgery, and this study did not address the outcome of patients who were conservatively treated.
AB - Background: The nature and prognosis of type A intramural hematoma (TAIMH) are not well established. In this study, we evaluated the early and late outcome after surgery for this emergency condition. Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) or TAIMH at 18 European centers for cardiac surgery. In this study, we compared the early and late outcomes of TAIMH and typical TAAD. Results: In total, 3902 consecutive patients were included in the ERTAAD registry, and 386 (9.9%) patients had TAIMH. Penn class a was present in 43.1% TAAD patients and in 34.5% TAIMH patients (p < 0.001). Among 3-month survivors, 10-year relative survival was 0.80 (95%CI 0.77–0.84) in TAAD patients and 0.76 (95%CI 0.63–0.88) in TAIMH patients. Propensity-score matching yielded 386 pairs of patients, and no significant difference was observed between the study groups in terms of early and late outcomes. In-hospital mortality rates were comparable (TAIMH 13.5% vs. TAAD 16.3%, p = 0.266). Ten-year mortality was 51.3% among TAIMH patients and 51.6% among TAAD patients (p = 0.274). TAIMH and TAAD had similar 10-year cumulative incidence rates of proximal (4.2% vs. 3.3%, p = 0.738) and distal aortic reoperations (12.6% vs. 7.6%, p = 0.779). Conclusions: This cohort study showed that the prevalence of patients with TAIMH requiring surgery is low and their risk profile is significantly different as shown by the Penn classification. The early and late outcomes of the study groups were not statistically different compared to typical TAAD when adjusted for baseline and operative variables. The relative survivals of 90-day TAIMH and TAAD survivors were low compared to the matched general population, indicating that surgically treated TAIMH demonstrated postoperative outcomes are poor and comparable to surgically treated TAAD after adjustment. Post-hoc power analysis suggested that much larger studies are needed to confirm these findings. These results are limited to TAIMH patients who underwent surgery, and this study did not address the outcome of patients who were conservatively treated.
KW - Aortic Disease and Treatment Approaches
KW - Aortic Disease and Treatment Approaches
KW - 3126 Surgery, anesthesiology, intensive care, radiology
U2 - 10.3390/jcdd13060247
DO - 10.3390/jcdd13060247
M3 - Article
C2 - 42346467
SN - 2308-3425
VL - 13
JO - Journal of Cardiovascular Development and Disease
JF - Journal of Cardiovascular Development and Disease
IS - 6
M1 - 247
ER -