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

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

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

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

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

6. Protocol Surgical Intervention Percutaneous Intervention 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) 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) 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) Hospital mortality 7.8% (24/308) Surgical mortality 15% (8/54) Non-surgical mortality 6.3% (16/254)

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

11. 11 Summary Mortality7.8% Complicated (41%)18% Uncomplicated (59%) 0.5% Morbidity remains significant Early Intervention 15% Mortality7.8% 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. 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.