Early survival analysis of acute type A aortic dissection and intramural hematoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANG Yi , LIN Hongyuan ,  GUO Hongwei

Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

GUO Hongwei, Email: ghwdr@sina.com

Keywords：

Acute type A aortic dissection; intramural hematoma; surgery; treatment

DOI：

10.7507/1007-4848.202004041

Video：

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Objective To explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma.Methods The clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23, 2020 to March 10, 2020 were retrospectively analyzed, including 43 males and 18 females, aged 22-81 (52.1±13.0) years. The patient's time of visit, clinical characteristics and early survival were analyzed. Kaplan-Mier survival curve and log-rank test were used for the survival analysis.Results There were 48 (78.7%) patients diagnosed with acute type A aortic dissection and 13 (21.3%) patients with intramural hematoma; 34 patients received operation and 11 were emergent. The 30-day mortality was 2.9% among the patients receiving operation. There were 48 patients alive and 13 patients dead during the study period. The cumulative survival rates for all the patients on postoperative 1 day, 3 days and 7 days were 93.4%, 86.4% and 77.5%, respectively. The cumulative survival rates for the patients with dissection on postoperative 1 day, 3 days and 7 days were 95.7%, 88.7% and 79.4%, respectively. The cumulative survival rates for the patients with hematoma on postoperative 1 day, 3 days and 7 days were 92.3%, 84.6% and 84.6%, respectively. The difference of survival rates between the two groups was not statistically significant (P>0.05). The cumulative survival rate of all the patients on postoperative 14 days was 74.5%. No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection (P>0.05). The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients (P<0.05).Conclusion Patients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy, and rupture of the dissection is the leading cause of death in these patients, especially for those with hemodynamic unstability.

Citation： CHANG Yi, LIN Hongyuan, GUO Hongwei. Early survival analysis of acute type A aortic dissection and intramural hematoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1025-1030. doi: 10.7507/1007-4848.202004041 Copy

1.	Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
2.	Hirst AE, Johns VJ, Kime SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore), 1958, 37(3): 217-279.
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6.	Estrera A, Miller C, Lee TY, <italic>et al</italic>. Acute type A intramural hematoma: analysis of current management strategy. Circulation, 2009, 120(11 Suppl): S287-S291.
7.	Kitai T, Kaji S, Yamamuro A, <italic>et al</italic>. Clinical outcomes of medical therapy and timely operation in initially diagnosed type A aortic intramural hematoma: a 20-year experience. Circulation, 2009, 120(11 Suppl): S292-S298.
8.	Mehta RH, Suzuki T, Hagan PG, <italic>et al</italic>. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9.	Czerny M, Schoenhoff F, Etz C, <italic>et al</italic>. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA Registry. J Am Coll Cardiol, 2015, 65(24): 2628-2635.
10.	Kawahito K, Adachi H, Yamaguchi A, <italic>et al</italic>. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg, 2001, 71(4): 1239-1243.
11.	Li ZD, Liu Y, Zhu J, <italic>et al</italic>. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. J Thorac Dis, 2017, 9(12): 4979-4987.
12.	Rampoldi V, Trimarchi S, Eagle KA, <italic>et al</italic>. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
13.	Pacini D, Leone A, Belotti LM, <italic>et al</italic>. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
14.	Eggebrecht H, Baumgart D, Dirsch O, <italic>et al</italic>. Percutaneous balloon fenestration of the intimal flap for management of limb threatening ischaemia in acute aortic dissection. Heart, 2003, 89(9): 973.
15.	Bartel T, Eggebrecht H, Ebradlidze T, <italic>et al</italic>. Images in cardiovascular medicine. Optimal guidance for intimal flap fenestration in aortic dissection by transvenous two-dimensional and Doppler ultrasonography. Circulation, 2003, 107(2): e17-e18.
16.	Beregi JP, Prat A, Gaxotte V, <italic>et al</italic>. Endovascular treatment for dissection of the descending aorta. Lancet, 2000, 356(9228): 482-483.

1. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
2. Hirst AE, Johns VJ, Kime SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore), 1958, 37(3): 217-279.
3. Masuda Y, Yamada Z, Morooka N, <italic>et al</italic>. Prognosis of patients with medically treated aortic dissections. Circulation, 1991, 84(5 Suppl): Ⅲ7-Ⅲ13.
4. Erbel R, Aboyans V, Boileau C, <italic>et al</italic>. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5. Evangelista A, Mukherjee D, Mehta RH, <italic>et al</italic>. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation, 2005, 111(8): 1063-1070.
6. Estrera A, Miller C, Lee TY, <italic>et al</italic>. Acute type A intramural hematoma: analysis of current management strategy. Circulation, 2009, 120(11 Suppl): S287-S291.
7. Kitai T, Kaji S, Yamamuro A, <italic>et al</italic>. Clinical outcomes of medical therapy and timely operation in initially diagnosed type A aortic intramural hematoma: a 20-year experience. Circulation, 2009, 120(11 Suppl): S292-S298.
8. Mehta RH, Suzuki T, Hagan PG, <italic>et al</italic>. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9. Czerny M, Schoenhoff F, Etz C, <italic>et al</italic>. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA Registry. J Am Coll Cardiol, 2015, 65(24): 2628-2635.
10. Kawahito K, Adachi H, Yamaguchi A, <italic>et al</italic>. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg, 2001, 71(4): 1239-1243.
11. Li ZD, Liu Y, Zhu J, <italic>et al</italic>. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. J Thorac Dis, 2017, 9(12): 4979-4987.
12. Rampoldi V, Trimarchi S, Eagle KA, <italic>et al</italic>. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg, 2007, 83(1): 55-61.
13. Pacini D, Leone A, Belotti LM, <italic>et al</italic>. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
14. Eggebrecht H, Baumgart D, Dirsch O, <italic>et al</italic>. Percutaneous balloon fenestration of the intimal flap for management of limb threatening ischaemia in acute aortic dissection. Heart, 2003, 89(9): 973.
15. Bartel T, Eggebrecht H, Ebradlidze T, <italic>et al</italic>. Images in cardiovascular medicine. Optimal guidance for intimal flap fenestration in aortic dissection by transvenous two-dimensional and Doppler ultrasonography. Circulation, 2003, 107(2): e17-e18.
16. Beregi JP, Prat A, Gaxotte V, <italic>et al</italic>. Endovascular treatment for dissection of the descending aorta. Lancet, 2000, 356(9228): 482-483.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early survival analysis of acute type A aortic dissection and intramural hematoma

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