This year, the Joint Committee on Clinical Practice Guidelines of the American Heart Association (AHA) and the American College of Cardiology (ACC) published an extensive guideline document for clinicians on the diagnosis and treatment of aortic disease. The aim of the document is to guide clinicians across all disciplines in the management of patients with aortic disease. Ourania Preventza, MD, MBA, FACS, a cardiac surgeon at The Texas Heart Institute with expertise in aortic surgery and professor of surgery at Baylor College of Medicine, was one of the leaders of this effort.

Periodically, the Joint Committee forms writing teams that thoroughly examine the latest clinical research to develop guidelines for diagnosing and treating various cardiovascular diseases. The last time the Joint Committee wrote the guidelines regarding thoracic aortic disease was in 2010.

This year, the Joint Committee assembled a writing committee of more than two dozen experts to produce the “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease.” The writing committee used previous recommendations and guidelines on thoracic aortic disease, peripheral arterial disease, and bicuspid aortic valve disease, as well as new evidence, to provide guidance to clinicians.

The writing committee was led by a chair, Eric Isselbacher, MD (a cardiologist at Massachusetts General Hospital in Boston), and two vice chairs: James Hamilton Black III, MD (a vascular surgeon at Johns Hopkins), and Dr. Preventza. The chair and vice chairs selected and assembled the committee’s other 26 members.

“Our process for forming the writing committee was designed to provide diverse perspectives,” Dr. Preventza says. “The physicians on the committee included not only cardiologists but also cardiothoracic surgeons, vascular surgeons, cardiovascular anesthesiologists, and geneticists with special knowledge about the diagnosis, genetic evaluation, medical and surgical therapy, and surveillance of patients with aortic disease. The committee also included a nurse practitioner with knowledge of aortic disease, and a patient advocate.”

This effort was the result of collaboration with and was endorsed by the American Association for Thoracic Surgery, American College of Radiology, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and Society for Vascular Surgery. A member of each of these societies was selected to represent that society on the committee. The guidelines were also endorsed by the Society of Interventional Radiology and the Society of Vascular Medicine.

Once assembled, the writing committee performed a wide-ranging search of several databases to identify articles that provide useful data about the diagnosis and treatment of various types of aortic disease. The entire endeavor took close to 2 years, with weekly meetings and reviews addressing different sections of the document.

The resulting article was published in both the AHA’s flagship journal, Circulation (2021 impact factor 39.92), and the ACC’s top journal, the Journal of the American College of Cardiology (JACC; 2020 impact factor 24.09). The comprehensive guideline makes many recommendations, and it also includes a “Top 10 Take-Home Messages” section that highlights the key ones. These recommendations include using a multidisciplinary aortic team to determine the best timing for intervention for each patient with aortic disease, adjusting the diameter threshold for surgery in patients with aortic aneurysm according to their body habitus, and considering using endovascular techniques for treating type B aortic dissection.

“These guidelines represent the best of our knowledge about aortic disease, assembled by some of the best minds in the field,” Dr. Preventza said. “They will be a valuable decision-making tool for clinicians for years to come.”

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Read Reports

Isselbacher EM, Preventza O, Black JH, 3rd, et al. 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. Circulation. 2022. doi:10.1161/CIR.0000000000001106.

Isselbacher EM, Preventza O, Hamilton Black J, 3rd, et al. 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. J Am Coll Cardiol. 2022. doi:10.1016/j.jacc.2022.08.004.

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News Story By Stephen N. Palmer, PhD, ELS

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