{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:27:19Z","timestamp":1760146039597,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T00:00:00Z","timestamp":1726272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: We have employed a conservative management approach, including intensive control of both blood pressure and heart rate, in patients with aortic intramural hematoma (AIMH) and retrograde thrombosed type A acute aortic dissection (RT-TAAAD), sharing common clinical and imaging characteristics. Methods: To evaluate the outcomes of our conservative management approach, we retrospectively reviewed the clinical records of 98 patients diagnosed with AIMH or RT-TAAAD from January 2008 to March 2023. A conservative management approach was applied, except for those patients with an aortic diameter \u2265 55 mm, false lumen expansion, or cardiac tamponade, who underwent emergency aortic repair. Results: Besides 2 patients, who declined surgery and subsequently died from aortic rupture, 18 patients underwent urgent aortic surgery, while 78 did not. Multivariable logistic regression analysis identified the extrusion type of ulcer-like projections (ULPs) on admission and a maximum aortic diameter \u2265 45 mm on Day 1 as risk factors for acute aortic surgery. Among the 78 patients who were discharged, 9 (12%) underwent aortic surgery, while 69 (88%) did not, with a median follow-up of 44 months. The overall actuarial aortic surgery-free rates were 78% at 1 year and 72% at 5 years, respectively. A Cox proportional hazards analysis identified ULPs and an aortic diameter \u2265 45 mm at discharge as risk factors for late aortic surgery. Conclusions: The early and late outcomes of our conservative strategy for AIMH and RT-TAAAD demonstrate favorable surgery-free rates. The extrusion type of ULPs on admission and an aortic diameter \u2265 45 mm on Day 1 are predictors of acute aortic surgery, while ULPs and an aortic diameter \u2265 45 mm at discharge are predictors of late surgery.<\/jats:p>","DOI":"10.3390\/jcm13185464","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T11:36:37Z","timestamp":1726486597000},"page":"5464","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early and Late Surgery-Free Rates of Conservative Management Strategy for Thrombosed Type A Acute Aortic Dissection and Acute Intramural Hematoma"],"prefix":"10.3390","volume":"13","author":[{"given":"Kiyotoshi","family":"Akita","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4623-6233","authenticated-orcid":false,"given":"Yoshiyuki","family":"Takami","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuo","family":"Maekawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Yamana","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Amano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuki","family":"Matsuhashi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wakana","family":"Niwa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1093\/icvts\/ivz222","article-title":"Natural courses and long-term results of type A acute aortic intramural haematoma and retrograde thrombosed type A acute aortic dissection: A single-centre experience","volume":"30","author":"Chen","year":"2020","journal-title":"Interact Cardiovasc. 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