• J. Thorac. Cardiovasc. Surg. · Jul 2022

    Stepwise external wrapping procedure for type A intramural hematoma.

    • Yoshihiro Suematsu, Takafumi Inoue, Satoshi Nishi, Kanan Kurahashi, Daisuke Arima, and Akihiro Yoshimoto.
    • Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan. Electronic address: suematus@tf7.so-net.ne.jp.
    • J. Thorac. Cardiovasc. Surg. 2022 Jul 1; 164 (1): 31-38.e1.

    BackgroundThe optimal treatment for Stanford type A acute intramural hematoma remains controversial, especially in elderly or high-risk patients.MethodsWe have developed a new surgical approach using artificial grafts (stepwise external wrapping) for high-risk patients. The aim of this study is to report our results using the stepwise external wrapping procedure in the treatment of high-risk patients with type A intramural hematoma. Among the 129 patients admitted for type A intramural hematoma between January 2016 and January 2020, 49 patients underwent stepwise external wrapping. The mean patient age was 78 ± 7 years. The new standard European system for cardiac operative risk evaluation II was 54% ± 23%. The mean overall operation and cardiopulmonary bypass times were 96 ± 13 minutes and 35 ± 10 minutes, respectively.ResultsThere were no hospital deaths. Two cases of temporary neurologic disorder, 1 case of renal failure, and 2 cases of wound infection occurred during the postoperative period. The intensive care unit and hospital stays were 2 ± 1 days and 10 ± 3 days, respectively. The thickness of intramural hematoma that had been the target of the stepwise external wrapping procedure decreased significantly from 18.0 ± 10.7 mm preoperatively to 5.2 ± 4.4 mm at 3 months after surgery (P < .05). The follow-up survival was 97.7% ± 4.4 % at 1 year after surgery and 89.8% ± 11.4% at 3 years after surgery. There was no aortic-related death during follow-up.ConclusionsOur stepwise external wrapping is a feasible alternative to conventional graft replacement for high-risk patients with type A intramural hematoma. The early and midterm outcomes of the procedure were satisfactory, but further careful follow-up is needed.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…