Abstract：
OBJECTIVE: To investigate the short-term/long-term impact of pulmonary artery intramural hematoma (PA-IMH) in patients with acute Stanford type A aortic dissection (ATAAD) following surgical repair.
METHODS: Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010-2021 were retrospectively reviewed. Patients with hemorrhage extending along the PA were identified as the PA-IMH group. Multivariable logistics regression was used to obtain the odds ratio (OR), and the Kaplan-Meier method was used to estimate the survival rate.
RESULTS: Of the 2046 ATAAD patients, 324 (15.8%) patients were identified with PA-IMH, and 1722 (84.2%) were without PA-IMH. PA-IMH had a higher prevalence in patients with older age, female gender, aortic IMH, and type II aortic dissection. PA-IMH patients incurred excess early mortality compared with non-PA-IMH patients (9.3% vs. 5.6%, OR = 1.86, 95%CI 1.19-2.91, p = 0.006). The results were stable in the subgroup analysis, with an increased risk in older (> 70 years) or DeBakey type II ATAAD patients. Notably, an increase in the degree and extent of PA-IMH exacerbated the risk of early mortality. However, after landmark analysis at 30-day postsurgery, no significant difference was noted in the long-term outcomes between PA-IMH and non-PA-IMH groups (p = 0.440). The 5-year survival rates were 87.1% (95%CI: 83.3%, 91.1%) and 90.1% (95%CI: 88.5%, 91.7%), respectively.
CONCLUSIONS: The presence of PA-IMH in ATAAD patients is common and is independently associated with increased early mortality after surgical repair, especially in those with older age (> 70) or type II dissection. However, such detrimental effects do not persist in the long-term follow-up among patients who survived hospital discharge.
CONCLUSIONS: We confirmed that PA-IMH significantly increases early postoperative mortality in patients with acute type A aortic dissection, especially in older patients or DeBakey type II dissection. This should prompt further investigation of the incremental role of PA-IMH in this pathology.
CONCLUSIONS: Acute type A aortic dissection mortality gets worse when pulmonary artery intramural hematoma is present. Pulmonary artery-intramural hematoma increased the risk of early mortality but not affect long-term prognosis. Further research should investigate the effects of pulmonary artery intramural thrombus on aortic dissection.
METHODS: Consecutive patients with ATAAD who received surgical repair at Beijing and Yunnan Fuwai Hospital in 2010-2021 were retrospectively reviewed. Patients with hemorrhage extending along the PA were identified as the PA-IMH group. Multivariable logistics regression was used to obtain the odds ratio (OR), and the Kaplan-Meier method was used to estimate the survival rate.
RESULTS: Of the 2046 ATAAD patients, 324 (15.8%) patients were identified with PA-IMH, and 1722 (84.2%) were without PA-IMH. PA-IMH had a higher prevalence in patients with older age, female gender, aortic IMH, and type II aortic dissection. PA-IMH patients incurred excess early mortality compared with non-PA-IMH patients (9.3% vs. 5.6%, OR = 1.86, 95%CI 1.19-2.91, p = 0.006). The results were stable in the subgroup analysis, with an increased risk in older (> 70 years) or DeBakey type II ATAAD patients. Notably, an increase in the degree and extent of PA-IMH exacerbated the risk of early mortality. However, after landmark analysis at 30-day postsurgery, no significant difference was noted in the long-term outcomes between PA-IMH and non-PA-IMH groups (p = 0.440). The 5-year survival rates were 87.1% (95%CI: 83.3%, 91.1%) and 90.1% (95%CI: 88.5%, 91.7%), respectively.
CONCLUSIONS: The presence of PA-IMH in ATAAD patients is common and is independently associated with increased early mortality after surgical repair, especially in those with older age (> 70) or type II dissection. However, such detrimental effects do not persist in the long-term follow-up among patients who survived hospital discharge.
CONCLUSIONS: We confirmed that PA-IMH significantly increases early postoperative mortality in patients with acute type A aortic dissection, especially in older patients or DeBakey type II dissection. This should prompt further investigation of the incremental role of PA-IMH in this pathology.
CONCLUSIONS: Acute type A aortic dissection mortality gets worse when pulmonary artery intramural hematoma is present. Pulmonary artery-intramural hematoma increased the risk of early mortality but not affect long-term prognosis. Further research should investigate the effects of pulmonary artery intramural thrombus on aortic dissection.
摘要：
目的：探讨手术修复后急性StanfordA型主动脉夹层(ATAAD)患者肺动脉壁间血肿(PA-IMH)的短期/长期影响。
方法：回顾性分析2010-2021年在北京和云南阜外医院接受手术修复的ATAAD患者。沿着PA延伸的出血患者被确定为PA-IMH组。多变量物流回归用于获得优势比(OR)，采用Kaplan-Meier法估计生存率。
结果：在2046名ATAAD患者中，324例（15.8%）患者被确定为PA-IMH，1722例（84.2%）无PA-IMH。PA-IMH在年龄较大的患者中患病率较高，女性性别,主动脉IMH,和II型主动脉夹层。与非PA-IMH患者相比，PA-IMH患者的早期死亡率过高（9.3％vs.5.6%,OR=1.86，95CI1.19-2.91，p=0.006）。亚组分析结果稳定,老年（>70岁）或DeBakeyII型ATAAD患者的风险增加。值得注意的是,PA-IMH程度和程度的增加加剧了早期死亡的风险.然而,在手术后30天的里程碑分析后，PA-IMH组和非PA-IMH组的长期结局无显著差异(p=0.440).5年生存率为87.1%(95CI:83.3%,91.1%)和90.1%(95CI：88.5%，91.7%)，分别。
结论：ATAAD患者中PA-IMH的存在是常见的，并且与手术修复后早期死亡率的增加独立相关。尤其是那些年龄较大（>70）或II型夹层。然而,在出院后幸存的患者中,这种有害影响在长期随访中并不持续.
结论：我们证实PA-IMH显著增加急性A型主动脉夹层患者术后早期死亡率，尤其是在老年患者或DeBakeyII型夹层中。这应该促使进一步研究PA-IMH在这种病理中的增量作用。
结论：当存在肺动脉壁内血肿时，急性A型主动脉夹层死亡率会恶化。肺动脉壁间血肿增加早期死亡的风险，但不影响长期预后。进一步的研究应探讨肺动脉壁内血栓对主动脉夹层的影响。
方法：回顾性分析2010-2021年在北京和云南阜外医院接受手术修复的ATAAD患者。沿着PA延伸的出血患者被确定为PA-IMH组。多变量物流回归用于获得优势比(OR)，采用Kaplan-Meier法估计生存率。
结果：在2046名ATAAD患者中，324例（15.8%）患者被确定为PA-IMH，1722例（84.2%）无PA-IMH。PA-IMH在年龄较大的患者中患病率较高，女性性别,主动脉IMH,和II型主动脉夹层。与非PA-IMH患者相比，PA-IMH患者的早期死亡率过高（9.3％vs.5.6%,OR=1.86，95CI1.19-2.91，p=0.006）。亚组分析结果稳定,老年（>70岁）或DeBakeyII型ATAAD患者的风险增加。值得注意的是,PA-IMH程度和程度的增加加剧了早期死亡的风险.然而,在手术后30天的里程碑分析后，PA-IMH组和非PA-IMH组的长期结局无显著差异(p=0.440).5年生存率为87.1%(95CI:83.3%,91.1%)和90.1%(95CI：88.5%，91.7%)，分别。
结论：ATAAD患者中PA-IMH的存在是常见的，并且与手术修复后早期死亡率的增加独立相关。尤其是那些年龄较大（>70）或II型夹层。然而,在出院后幸存的患者中,这种有害影响在长期随访中并不持续.
结论：我们证实PA-IMH显著增加急性A型主动脉夹层患者术后早期死亡率，尤其是在老年患者或DeBakeyII型夹层中。这应该促使进一步研究PA-IMH在这种病理中的增量作用。
结论：当存在肺动脉壁内血肿时，急性A型主动脉夹层死亡率会恶化。肺动脉壁间血肿增加早期死亡的风险，但不影响长期预后。进一步的研究应探讨肺动脉壁内血栓对主动脉夹层的影响。
