초록접수 현황
| 16F-253 | 구연 발표 |
Outcome of type A Aortic Dissection and Intramural Hematoma: Optimal Management in Acute type A Intramural Hematoma?
Tae-Hoon Kim¹, Suk-Won Song¹, Won-Ki Woo¹, Min-young Beak¹, Kyung-Jong Yoo², Bum-Koo Cho²
¹Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, ²Department of Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : Acute type A aortic dissection (ATAAD) and intramural hematoma (ATAIMH) are equally fatal disease. However, optimal management of ATAIMH is controversial. We sought to analyze the outcomes after open repair of ATAIMH and ATAAD.
Methods : Three hundred eighteen patients underwent open repair for ATAAD or ATAIMH between 2008 and 2016. We assessed the cutoff point of initial hematoma thickness and ascending aorta diameter for predicting emergence of intima tear.
Results : Of 318 patients, 36 patients with ATAIMH were significantly older, and had more hypertension than ATAAD (66.1±12.9 vs. 58.7±14.4, p=0.003; 80.6% vs. 62.1%, p=0.041, respectively) (Table 1). During the open repair of ATAIMH, intima tear which was not detected on preoperative computed tomography (CT) was found at ascending or aortic arch (24.2 % of ATAIMH and 40% of female ATAIMH). Multivariate analysis revealed female gender, large aortic root and aortic arch diameter were independent risk factors for emergence of intima tear in ATAIMH. The best cut off values for presence of intima tear were hematoma thickness (10mm) and ascending aorta diameter (49 mm for female, 52 mm for male) (AUC=0.745, 95%CI 0.553-0.937, p=0.040, AUC=0.735, 95%CI 0.551-0.919, p=0.048, respectively). A significantly lower incidence of postoperative dialysis and acute renal failure in ATAIMH was noted (0% vs.11.3%, p=0.035; 2.8% vs.16.7%, p=0.025, respectively). ATAIMH has significantly lower 30-day and overall mortality than ATAAD (0% Vs. 13.1%, p=0.013; 2.8% Vs. 15.6%, p=0.04, respectively).
Conclusion : ATAIMH is also potentially a fatal one. Our study represent that open repair in ATAIMH has remarkably good outcomes in mortality and complications compared to classic ATAAD. Emergent surgical treatment in ATAIMH is strongly recommended if mural hematoma is thick (>10mm) or even if ascending aortic diameter is relatively small (<50mm).
Methods : Three hundred eighteen patients underwent open repair for ATAAD or ATAIMH between 2008 and 2016. We assessed the cutoff point of initial hematoma thickness and ascending aorta diameter for predicting emergence of intima tear.
Results : Of 318 patients, 36 patients with ATAIMH were significantly older, and had more hypertension than ATAAD (66.1±12.9 vs. 58.7±14.4, p=0.003; 80.6% vs. 62.1%, p=0.041, respectively) (Table 1). During the open repair of ATAIMH, intima tear which was not detected on preoperative computed tomography (CT) was found at ascending or aortic arch (24.2 % of ATAIMH and 40% of female ATAIMH). Multivariate analysis revealed female gender, large aortic root and aortic arch diameter were independent risk factors for emergence of intima tear in ATAIMH. The best cut off values for presence of intima tear were hematoma thickness (10mm) and ascending aorta diameter (49 mm for female, 52 mm for male) (AUC=0.745, 95%CI 0.553-0.937, p=0.040, AUC=0.735, 95%CI 0.551-0.919, p=0.048, respectively). A significantly lower incidence of postoperative dialysis and acute renal failure in ATAIMH was noted (0% vs.11.3%, p=0.035; 2.8% vs.16.7%, p=0.025, respectively). ATAIMH has significantly lower 30-day and overall mortality than ATAAD (0% Vs. 13.1%, p=0.013; 2.8% Vs. 15.6%, p=0.04, respectively).
Conclusion : ATAIMH is also potentially a fatal one. Our study represent that open repair in ATAIMH has remarkably good outcomes in mortality and complications compared to classic ATAAD. Emergent surgical treatment in ATAIMH is strongly recommended if mural hematoma is thick (>10mm) or even if ascending aortic diameter is relatively small (<50mm).
책임저자: Suk-Won Song
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Tae-Hoon Kim, E-mail : airtech2@naver.com