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Aortic Surgery Symposium 2010 New York, NY April, 2010

Acute Type A Intramural Hematoma: Analysis of Current Management Strategy. Anthony Estrera, MD, Charles Miller, III, PhD, Taek-Yeon Lee, MD, Paola De Rango, MD, MD, T. Kaneko, MD, Hazim Safi, MD. Department of Cardiothoracic and Vascular Surgery

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Aortic Surgery Symposium 2010 New York, NY April, 2010

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  1. Acute Type A Intramural Hematoma: Analysis of Current Management Strategy Anthony Estrera, MD, Charles Miller, III, PhD, Taek-Yeon Lee, MD, Paola De Rango, MD, MD, T. Kaneko, MD, Hazim Safi, MD Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute Aortic Surgery Symposium 2010 New York, NY April, 2010

  2. Background Acute Type A IMH Stable Unstable, Tamponade Initial Medical Optimize Urgent Surgery Emergent Surgery (pericardial window)

  3. Purpose • Analyze our experience managing acute Type A intramural hematoma • Compare outcomes with Typical Acute Type A dissection • Validate our treatment approach

  4. Methods 251 Acute Type A Aortic Dissection Oct. 1999 – May 2008 Median age: 62 (21-91) 64% 36% 36 IMH (14%)

  5. Methods 36 Patients (IMH) 7 Patients (19%) Repaired On Presentation 1 Patient (3%) Medical Management Only 28 Patients (78%) Managed With Optimal Medical Management With Eventual Surgical Treatment

  6. Methods

  7. IMH vs. Typical Preoperative

  8. IMH vs. Typical Intra-operative

  9. IMH vs. Typical Post-operative

  10. Results by Approach

  11. Risk of Conversion

  12. Conclusions • Despite optimal medical management, conversion of Type A IMH to typical dissection still remains a concern with the most significant risk beyond 8 days. • In our patient population, although purposeful delay can be safely achieved in certain patients, timely surgical repair is recommended.

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