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Guideline Developed for Diagnosis, Management of Aortic Disease

Shared decision-making involving patient and multidisciplinary aortic team encouraged to determine optimal therapies

THURSDAY, Nov. 3, 2022 (HealthDay News) — In a 2022 guideline issued by the American College of Cardiology and the American Heart Association and published online Nov. 2 in Circulation, recommendations are presented for the diagnosis and management of aortic disease, focusing on the importance of a multidisciplinary aortic team.

Eric M. Isselbacher, M.D., from Massachusetts General Hospital in Boston, and colleagues conducted a comprehensive literature search to develop recommendations on the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease.

The authors note that multidisciplinary aortic team care should be considered in determining the appropriate timing of intervention. To determine the optimal medical, endovascular, and open surgical therapies, shared decision-making involving the patient and multidisciplinary team is encouraged. Shared decision-making is especially important for patients with aortic disease who are contemplating pregnancy or who are pregnant. The threshold for surgical intervention for sporadic aortic root and ascending aortic aneurysms has been lowered from 5.5 cm to 5.0 cm in selected patients at centers with multidisciplinary aortic teams and experienced surgeons; in specific scenarios among patients with heritable thoracic aortic aneurysms, the threshold can be even lower. Surgical thresholds may incorporate indexing of the aortic root or ascending aortic diameter to patient body surface area or height, or the aortic cross-sectional area to patient height in patients who are significantly shorter or taller than average.

“We hope this new guideline can inform clinical practices with up-to-date and synthesized recommendations, targeted toward a full multidisciplinary aortic team working to provide the best possible care for this vulnerable patient population,” Isselbacher said in a statement.

Several authors disclosed financial ties to the biopharmaceutical and health care industries.

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