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
Purpose
• Analyze our experience with Acute
Type B Aortic dissection using a
standardized medical management
protocol
2
Methods
January 2001 – May 2009
308 Acute Type B Dissection
65%
35%
Median age was 62 years (16-94)
Complicated Dissection
• Rupture
• Mal-perfusion
• Stroke/Coma
• Paraplegia
• Visceral-Bowel,
Hepatic
• Renal failure
• Peripheral vascular
4
Protocol
Admit CVICU
C-line, arterial line, UOP
B-Blocker
Ca+2 Blocker
Nitroglycerin
Nitroprusside
Anti-impulse Therapy
SBP<120, MAP<80
Control pain
Reassessment
Blood pressure
Pain
Respiratory
DVT prevent
Nutrition
Mobilization
Protocol
Surgical Intervention
Percutaneous Intervention
Rupture/Leak
Mal-perfusion (visceral, peripheral)
Acute Expansion
Refractory Symptoms
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)
Results
• ICU LOS
8 days (1-58 days)
• LOS
15 days (1-88 days)
Results
Hospital mortality 7.8% (24/308)
Surgical mortality 15% (8/54)
Non-surgical mortality
6.3% (16/254)
Results
(N=308)
Incidence
Mortality
Complicated
41%
18%
Uncomplicated
59%
0.5%
(p<0.0003)
Summary
• Mortality
7.8%
• Complicated
(41%)
18%
• Uncomplicated
(59%)
0.5%
• Morbidity remains significant
• Early Intervention
15%
11
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.