Initial Medical Treatment for Acute Type A Intramural Hematoma and Aortic Dissection

Background. There are contradictory reports on outcomes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. We evaluated short-term clinical outcomes and predictors of adverse outcomes. Methods. We retrospectively analyzed 59 symptomatic patients with type A acute IMH and AAD with thrombosed thoracic false lumens who initially received treatment. Survival, aortic death (death from aortic events and sudden deaths), and aortic event-free survival rates were investigated. False lumen thickness ratios (FTR [false lumen thickness/aortic diameter]) were measured by computed tomography scan and the relationship with aortic events was evaluated. Results. Survival, aortic death-free survival, and aortic event-free survival rates at 2 years were 90.0%, 96.6%, and 55.8%, respectively. Ascending aortic diameters, false lumen thickness of the ascending aortas, and rate of penetrating aortic ulcers in the ascending aortas were higher among patients with aortic events. The FTR of the ascending aorta (FTRA)/FTR of the descending aorta (FTRD) was also higher in these patients (1.3 +/- 0.9 versus 0.8 +/- 0.5, p = 0.0021). Multivariate analysis revealed FTRA/FTRD greater than 0.98 (odds ratio 5.35; 95% confidence interval: 0.05 to 1.72; p = 0.0431) as an independent predictor of aortic events. An FTRA/FTRD greater than 0.98 predicted aortic events with 87.1% sensitivity and 58.4% specificity. Conclusions. High aortic event rates were seen after treatment for type A acute IMH and AAD with thrombosed thoracic false lumens. Nevertheless, short-term survival rates were favorable. An FTRA/FTRD greater than 0.98 may be a highly sensitive predictor for aortic events. (C) 2013 by The Society of Thoracic Surgeons