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Aortic Surgery Symposium 2010 New York, NY April, 2010

Acute Type B Aortic Dissection: Results of a Standardized Management Protocol. Anthony Estrera, MD, C.D. Nugent, BA, Jennifer Goodrick, RN, Charles Miller, III, PhD, Hazim Safi, MD. Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston

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Aortic Surgery Symposium 2010 New York, NY April, 2010

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  1. Acute Type B Aortic Dissection: Results of a Standardized Management Protocol Anthony Estrera, MD, C.D. Nugent, BA, Jennifer Goodrick, RN, Charles Miller, III, PhD, Hazim Safi, MD Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute Aortic Surgery Symposium 2010 New York, NY April, 2010

  2. Purpose • Analyze our experience with Acute Type B Aortic dissection using a standardized medical management protocol

  3. Methods January 2001 – May 2009 308 Acute Type B Dissection 65% 35% Median age was 62 years (16-94)

  4. Complicated Dissection • Rupture • Mal-perfusion • Stroke/Coma • Paraplegia • Visceral-Bowel, Hepatic • Renal failure • Peripheral vascular

  5. Admit CVICU C-line, arterial line, UOP Anti-impulse Therapy SBP<120, MAP<80 Control pain B-Blocker Ca+2 Blocker Nitroglycerin Nitroprusside Respiratory DVT prevent Nutrition Mobilization Protocol Reassessment Blood pressure Pain

  6. Surgical Intervention Percutaneous Intervention Protocol Rupture/Leak Mal-perfusion (visceral, peripheral) Acute Expansion Refractory Symptoms

  7. IV Medications • 98% required one IV medication • 80% required multiple IV medications • Median time SBP < 140 mmHG 48 hr (0-720 hr) • Median time control pain 48 hr (0-264 hr)

  8. Results • ICU LOS 8 days (1-58 days) • LOS 15 days (1-88 days)

  9. Results Hospital mortality 7.8% (24/308) Surgical mortality 15% (8/54) Non-surgical mortality 6.3% (16/254)

  10. Results (N=308) Complicated 41% 18% Uncomplicated 59% 0.5% (p<0.0003) Incidence Mortality

  11. Summary • Mortality 7.8% • Complicated (41%) 18% • Uncomplicated (59%) 0.5% • Morbidity remains significant • Early Intervention 15%

  12. Conclusions • Medical management for acute type B aortic dissection (uncomplicated) is associated with acceptable outcomes. • Outcomes of complicated acute type B aortic dissection may warrant use of endovascular approaches.

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