Retrospective analysis of 50 consecutive patients with acute type A aortic intramural hematoma (AIH) was performed to evaluate the impact of initial treatment strategy on long-term outcome. Eleven patients (22%) underwent early surgery (Group [Gr] 1) and among 39 pts who received initial medical treatment (Group [Gr] 2), 6 (15%) underwent late surgical intervention (Fig). The overall hospital mortality was 8% and there was no significant difference between groups (9.1% in Gr 1 vs. 7.7% in Gr 2, p>.05). A total of 7 pts died during follow-up (42.1짹31.0 months) including 4 of the AIH-related death. The overall survival rates at 1, 2 and 5 years were 88짹5%, 83짹5% and 79짹7%, respectively. The overall survival rates for Gr 2 at 1, 2, 5 and 8 years were 90짹5%, 87짹6%, 82짹7%, and 71짹11%, respectively; the values were 82짹12%, 72짹14%, 72짹14%, and 48짹22% for Gr 1. The survival rates according to initial treatment strategies were not significantly different form each other (p= 0.35). Conclusions: Patients with acute type A AIH showed similar long-term outcomes regardless of the initial treatment strategy, which supports the idea that initial medical treatment with timed surgery in selected patients can be a rational treatment option.