Multicenter retrospective observational study of conservative management for acute type A intramural hematoma.

Abstract

To investigate the outcomes of patients treated conservatively for type A intramural hematoma (TAIMH). A multicenter retrospective analysis was conducted on patients with TAIMH between April 2011 and June 2023. Of 166 patients who underwent initial medical treatment, 122 were treated without surgery during the index admission (MT group), the primary focus of this study. For comparison, 44 patients who crossed over to surgery (CO group) and 91 patients who underwent immediate surgery (EM group) were analyzed as well. The mean maximum ascending aortic diameter (AOD) and hematoma thickness were 44.4 ± 5.5 mm and 7.9 ± 3.3 mm in the MT group, 47.2 ± 5.2 mm and 8.9 ± 3.4 mm in the CO group, and 49.2 ± 5.5 mm and 12.7 ± 5.5 mm in the EM group. The in-hospital mortality rate was 9.8% in the MT group, 9.1% in the CO group and 8.8% in the EM group. the In MT group, multivariable logistic regression identified maximum AOD as a predictor of in-hospital death (P < .05), aortic death (P < .05), and the composite outcome of in-hospital death and disease progression (P = .02). The 5-year survival rate was 85.5% in the MT group, 89.1% in the CO group, and 88.3% in the EM group. In the MT group, multivariable Cox regression analysis identified maximum AOD as a predictor of overall survival (hazard ratio, 1.10; 95% confidence interval, 1.00-1.21; P = .05). Conservative management of patients with TAIMH offers favorable outcomes; however, a larger maximum AOD was associated with worse short-term and mid-term outcomes.