Evaluation of Surgical Outcomes of Type A Intramural Hematoma

Gencpinar, Tugra; Topak, Reha; Alataş, Özkan; Gülcü, Aytaç; Bayrak, Serdar; Erdal, Cenk

doi:10.21470/1678-9741-2020-0223

Cited by 1 publication

(1 citation statement)

References 18 publications

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“…Specific TAIMH imaging and clinical features set the indication for operative repair over conservative management as they are considered predictive for future aortic adverse events, as dissection and aneurysm formation [1,3,[21][22][23][24]26]. Bentall operation, total or hemiarch replacement, frozen elephant trunk or tube graft interposition of the ascending aorta may be applied in TAIMH cases while in high-risk patients, external aortic wrapping may be used to reduce the peri-operative mortality [13,[27][28][29][30][31].…”

Section: Open Repairmentioning

confidence: 99%

Ascending aortic intramural hematoma: current concepts

Nana

Kouvelos

Σπανός

2022

Current Opinion in Cardiology

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Purpose of reviewType A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.Recent findingsRecent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.SummaryDespite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.

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