Watch-and-wait strategy for type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta: a Japanese single-centre experience. (3rd April 2020)

• Record Type: Journal Article
• Authors: Kitamura, Tadashi; Torii, Shinzo; Miyamoto, Takashi; Mishima, Toshiaki; Ohkubo, Hirotoki; Fujioka, Shunichiro; Yakuwa, Kazuki; Araki, Haruna; Kondo, Shin; Tamura, Yoshimi; Tadokoro, Yuki; Onishi, Yoshihiko; Miyaji, Kagami
• Is Part Of: European journal of cardio-thoracic surgery. Volume 58:Number 3(2020)
• Page Start: 590
• Page End: 597
• Publication Date: 2020-04-03
• Subjects: Acute type A aortic dissection -- Intramural haematoma -- Medical treatment; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa080
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: In this study, we investigated the early and midterm outcomes of initial watch-and-wait strategy for Stanford type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta in patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection in the ascending aorta. METHODS: Inpatient and outpatient records were retrospectively reviewed. RESULTS: Of the 81 patients with type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta between April 2011 and April 2019, a watch-and-wait strategy was selected in 46 patients. The mean age of the patients was 68 years, and 22 (48%) patients were female. Ten patients underwent emergency pericardial drainage for cardiac tamponade at the time of presentation and 8 patients underwent aortic repair during hospitalization for new ulcer-like projection, re-dissection or rupture. In-hospital mortality occurred in 2 (4%) patients. During follow-up, survival at 1 and 2 years was 95% and 92%, respectively. There was no significant difference in survival or aortic events between patients in whom the watch-and-wait strategy and emergency surgical treatment were indicated. CONCLUSIONS: The early and midterm outcomes of the initial watch-and-wait strategy were favourable for type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta in Japanese patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection. Further study is required to show the safety of this strategy.