Patients with Intramural Hematomas of the Ascending aorta do not have better outcomes than patients with Aortic Dissections.

P0250 

Abstract Submission 

Anthony Lemaire (1), Sorasicha Nithikasem (2), Abhishek Chakraborty (1), George Hung (1), Hirohisa Ikegami (1), Manabu Takebe (1), Gengo Sunagawa (1), Mark Russo (3), Leonard Lee (4)

(1) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (2) Rutgers Robert Wood Johnson Medical School, United States, (3) Robert Wood Johnson University Hospital, Green Village, NJ, (4) Robert Wood Johnson University Hospital, New Brunswick, NJ

*Anthony Lemaire    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Sorasicha Nithikasem    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Abhishek Chakraborty    -  Contact Me
Rutgers Robert Wood Johnson Medical School

George Hung    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Hirohisa Ikegami    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Manabu Takebe    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Gengo Sunagawa    -  Contact Me
Rutgers Robert Wood Johnson Medical School

*Mark Russo    -  Contact Me
Robert Wood Johnson University Hospital

*Leonard Lee    -  Contact Me
Robert Wood Johnson University Hospital

*Anthony Lemaire    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Objective:
Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic and Hemiarch repair.

Methods: This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending Aortic and Hemiarch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p<0.05.

Results: A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n=27] vs. 3% [n=80]; p=0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.

Conclusions: Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic and Hemiarch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings were surprising as we anticipated an improved outcome for patients with the Intramural hematoma. The results of this study will be further explored in additional studies.

Ascending Aorta