초록접수 현황
| 20F-073 | 구연 발표 |
Hematoma thickness ratio : Reconsidering of treatment modality for Acute type A intramural hematoma with invisible origin
Myeong su Kim¹, Tae-Hoon Kim¹, Ha Lee¹, Seung jun Song², Wan Kee Kim², Suk-Won Song¹, Kyung-Jong Yoo³
¹ Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
² Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
³ Department of Thoracic and Cardiovascular Surgery, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
² Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
³ Department of Thoracic and Cardiovascular Surgery, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : Reviewing the major adverse aortic event (MAAE) after surgery for acute type A intramural hematoma (ATAIMH), we wondered whether we could predict MAAE through preoperative computed tomography.
Methods : We retrospectively analyzed 51 patients with ATAIMH who underwent surgery from 2008 to 2019. The maximal thickness of the hematoma, the maximal diameter of aorta, and the hematoma thickness (HT) ratio (HTR [hematoma thickness/ aortic diameter]) were measured at the ascending and descending aorta. For the descending aorta, measurements were taken at the 5 different levels. Those are left subclavian artery (LSA), 2cm distal to LSA (LSA2), bifurcation of the pulmonary arteries, inferior vena cava-right atrium junction and celiac axis.
Results : The 10-year survival and MAAE-free survival rates were 96.1% and 56.9%, respectively. The average time to the occurrence of MAAE was 28 months (range, 0 to 75). Median follow up duration was 42 months (range, 0 to 135). HTR of the ascending aorta (aHTR)/HTR of descending aorta (dHTR) were significantly lower in patients who experienced MAAE. HTR of LSA2 was higher in MAAE (+) group. HT of Descending aorta (dHT) > 9.18mm and dHTR > 24% were also significantly higher in MAAE (+) group. aHTR/ dHTR, aHTR/dHTR < 0.86 and dHTR > 24% were independent predictors of MAAE in the multivariate analysis.
Conclusion : Our study indicates that the treatment modality ATAIMH should be reconsidered according to its origin. An important thing is the maximal diameter and hematoma thickness ratio of descending aorta, and this can be useful clues in invisible origin ATAIMH.
Methods : We retrospectively analyzed 51 patients with ATAIMH who underwent surgery from 2008 to 2019. The maximal thickness of the hematoma, the maximal diameter of aorta, and the hematoma thickness (HT) ratio (HTR [hematoma thickness/ aortic diameter]) were measured at the ascending and descending aorta. For the descending aorta, measurements were taken at the 5 different levels. Those are left subclavian artery (LSA), 2cm distal to LSA (LSA2), bifurcation of the pulmonary arteries, inferior vena cava-right atrium junction and celiac axis.
Results : The 10-year survival and MAAE-free survival rates were 96.1% and 56.9%, respectively. The average time to the occurrence of MAAE was 28 months (range, 0 to 75). Median follow up duration was 42 months (range, 0 to 135). HTR of the ascending aorta (aHTR)/HTR of descending aorta (dHTR) were significantly lower in patients who experienced MAAE. HTR of LSA2 was higher in MAAE (+) group. HT of Descending aorta (dHT) > 9.18mm and dHTR > 24% were also significantly higher in MAAE (+) group. aHTR/ dHTR, aHTR/dHTR < 0.86 and dHTR > 24% were independent predictors of MAAE in the multivariate analysis.
Conclusion : Our study indicates that the treatment modality ATAIMH should be reconsidered according to its origin. An important thing is the maximal diameter and hematoma thickness ratio of descending aorta, and this can be useful clues in invisible origin ATAIMH.
첨부파일 : table & figure.docx
책임저자: Suk-Won Song
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Myeong su Kim, E-mail : mmotion11@gmail.com