New Aortic Disease Guidelines Emphasize Team Approach, Family Screening, Early Surgery

Current guidelines for the diagnosis and management of aortic disease focus on the importance of a multidisciplinary aortic team, surgical intervention considerations, and genetic and family screening.

Published jointly by the American College of Cardiology and the American Heart Association, this guideline summarizes both thoracic and abdominal aortic guidelines and is intended for general cardiovascular care clinicians, including emergency care, to treat aortic disease. It is intended for cardiologists who care for people with Clinician.

“Previous ACC/AHA guidelines focused on thoracic aortic disease were published in 2010.” Eric M. Isselbacher, MD, MScFACC, Director of the Healthcare Transformation Lab at Massachusetts General Hospital, co-director of the Thoracic Aorta Center, and chairman of the guideline development committee, he told Healio. Remarkable advances have been made in both surgical and endovascular techniques for thoracic aortic disease.In addition, significant progress has been made in understanding symptomatic and hereditary thoracic aortic disease.All of these advances will be included in the new 2022 Aortic Disease Guidelines. It’s organized and highlighted, making it a great modern resource for clinicians.”

Updated lower threshold for surgery

The updated guidelines state that centers with multidisciplinary aortic teams and experienced surgeons should: Sporadic aortic root and ascending aortic aneurysms It dropped from 5.5 cm to 5 cm in selected patients, and even lower in the specific scenario of patients with hereditary thoracic aortic aneurysms, Isselbacher said. In addition, because aneurysms of the aortic root or ascending aorta may be familial even when not associated with a known syndrome, first-degree relatives should be screened to detect unsuspected aortic disease in the family. screening is recommended.

Isselbacher told Healio:

The guidelines also Imaging consistencySpecifically, how CTs and MRIs are acquired and reported, how often the images are used for monitoring aortic size and characteristics, and for monitoring before and after restorative surgery and other interventions. The guidelines recommend that all surveillance of a patient’s imaging be done in the same laboratory using the same modality when possible.
We also recommend modifying the surgical threshold for patients who are significantly smaller or taller than average.

Shared decision-making involving a multidisciplinary aortic team engages patients in decision-making, especially if individuals are at borderline thresholds for repair or if they are eligible for different types of surgical repair. is strongly recommended.

Addressing research gaps

According to Isselbacher, several research gaps remain in treating aortic disease.

“The timing of aortic aneurysm intervention is still largely based on the diameter of the aneurysm, but we know that many patients dissect at diameters well below the standard threshold,” Isselbacher said. “With advances in genetics, the discovery of biomarkers, and an improved understanding of the biomechanical properties of the aorta, it is clear that there is a need to identify other, more individualized predictors of aortic adverse events,” he told Healio. it is clear.”

Isselbacher also said more research is needed to better understand how gender, race, ethnicity and patient size influence the natural history and optimal management of aortic disease. I was.

The guidelines were published simultaneously in the Journal of the American College of Cardiology and Circulation. and was Developed and approved in collaboration with the American College of Thoracic Surgeons, the American College of Radiology, the Society of Cardiovascular Anesthesia, the Society of Cardiovascular Angiography and Interventions, the Society of Thoracic Surgeons, and the Society of Vascular Surgeons. It was approved by the Society of Interventional Radiology and the Society for Vascular Medicine.

For more information:

Eric M. Isselbacher, MD, MSc, can be reached by [email protected].