2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

On November 2, 2022, the American College of Cardiology (ACC) and American Heart Association (AHA) published an update to the 2010 ACC/AHA Guidelines for the Diagnosis and Management of Aortic Disease.

The top ten take-home messages are:

1. Multidisciplinary aortic team care in higher volume centers is considered when determining the appropriate timing of intervention.

2. Shared decision-making involving the patient and a multidisciplinary team is highly encouraged to determine the optimal medical, endovascular, and open surgical therapies, particularly in patients with aortic disease who are contemplating pregnancy or who are pregnant.

3. Computed tomography, magnetic resonance imaging, and echocardiographic imaging of patients with aortic disease should follow recommended approaches.

4. In multidisciplinary and experienced centers, the threshold for surgical intervention for sporadic root and ascending aortic aneurysms has been lowered from to 5.0 cm in selected patients, and even lower in patients with heritable thoracic aortic aneurysms.

5. For significantly smaller or taller patients, surgical thresholds may incorporate indexing of the aortic root or ascending aortic diameter to either height or body surface area, or the aortic cross-sectional area to patient height.

6. Rapid root growth or ascending aneurysm growth is defined as ≥0.5 cm in one year or ≥0.3 cm per year in two consecutive years for those with sporadic aneurysms, and ≥0.3 cm in one year for those with heritable thoracic aortic disease or bicuspid aortic valve.

7. During aortic root replacement, valve-sparing aortic root replacement is reasonable if the valve is suitable for repair and when performed by experienced surgeons in a multidisciplinary aortic team.

8. Clinically stable patients with acute type A aortic dissection should be considered for transfer to a high-volume aortic center to improve survival. Operative repair of type A aortic dissection should entail at least an open distal anastomosis rather than just a simple supracoronary interposition graft.

9. There is an increasing role for TEVAR in the management of uncomplicated type B dissection. Clinical trials on thoracoabdominal aortic aneurysm repair with endografts are reporting results that suggest endovascular repair is an option for patients with suitable anatomy.

10. Screening of first-degree relatives with aortic imaging is recommended for patients with aneurysms of the aortic root or ascending aorta, or those with aortic dissection.