Slide 1

Long-term Follow-up of Aortic Intramural Hematomas and Penetrating Ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli, RN, John A. Rizzo, PhD, John A. Elefteriades, MD Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine New Haven, Connecticut, USA Presented at the 95 th Annual Meeting of the American Association of Thoracic Surgery April 28 th, 2015 1

Slide 2

Disclosures Alan S. Chou, BA: Nothing to disclose. Bulat A. Ziganshin, MD: Nothing to disclose. Paris Charilaou, MD: Nothing to disclose. Maryann Tranquilli, RN: Nothing to disclose. John A. Rizzo, PhD: Nothing to disclose. John A. Elefteriades, MD: DSMB for Jarvik Heart, Solus Valve; Research Grant Vascutek; Medical Director for CoolSpine. 2

Slide 3

Acute Aortic Syndromes 3 Elefteriades JA. Thoracic aortic aneurysm: reading the enemys playbook. Curr Probl Cardiol. 2008;33:20377.

Slide 4

Current literature/evidence 4

Slide 5

5

Slide 6

US and European Guidelines 6

Slide 7

Aim of the study To evaluate the long-term natural history and progression of intramural hematomas and penetrating aortic ulcers including clinical and radiological follow-up and survival analysis. 7

Slide 8

Progression of Lesions 8

Slide 9

9 Resolution

Slide 10

Progression of Lesions 10 Resolution No Change (Stable)

Slide 11

Progression of Lesions 11 Resolution No Change (Stable) Worsening

Slide 12

Patient profile 12 108 consecutive patients (1995-2014) 108 consecutive patients (1995-2014)

Slide 13

Patient profile 13 108 consecutive patients (1995-2014) 108 consecutive patients (1995-2014) 55 IMH patients (51%) 55 IMH patients (51%) 53 PAU patients (49%) 53 PAU patients (49%)

Slide 14

Patient profile 14 108 consecutive patients (1995-2014) 108 consecutive patients (1995-2014) 55 IMH patients (51%) 55 IMH patients (51%) 56% Female 53 PAU patients (49%) 53 PAU patients (49%) 57% Female

Slide 15

Patient profile 15 108 consecutive patients (1995-2014) 108 consecutive patients (1995-2014) 55 IMH patients (51%) 55 IMH patients (51%) 56% Female 53 PAU patients (49%) 53 PAU patients (49%) 57% Female All patients were symptomatic at presentation All patients were symptomatic at presentation

Slide 16

Age of IMH and PAU Patients 16 Mean age IMH 70.310 yrs Mean age PAU 71.410 yrs

Slide 17

Location Distribution 17

Slide 18

Intramural Hematoma 18

Slide 19

Hospital Course of IMH 19 55 Patients with IMH 55 Patients with IMH

Slide 20

Hospital Course of IMH 20 55 Patients with IMH 55 Patients with IMH 82% Non-Rupture State (n = 45) 82% Non-Rupture State (n = 45) 18% Rupture State (n = 10) 18% Rupture State (n = 10)

Slide 21

Hospital Course of IMH 21 55 Patients with IMH 55 Patients with IMH 82% Non-Rupture State (n = 45) 82% Non-Rupture State (n = 45) 18% Rupture State (n = 10) 18% Rupture State (n = 10) Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections. Penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin 1999;17:637-57. High incidence of rupture at presentation compared with 8% and 4% for classic Type A and B dissection previously observed (p