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

Abstract

Aim: The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). Methods: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

“…Through animal tests, Suga and Sagawa(16) developed a ventricular pressure-volume relationship that can be expressed as a time-varying function E(t), as indicated in Equation (1): where E(t) is the time-varying function (mmHg/ml), P sv (t) is the time function of ventricular pressure (mmHg), V sv (t) is a time function of ventricular volume (ml), and V 0 is the ventricular reference volume (ml), which is the theoretical volume relative to ventricular zero pressure. Boston(17) proposed a mathematical fit to determine the function of ventricular systole according to equation (2): where E max refers to the ventricular pressure-volume relation at end-systole, E min refers to the ventricular pressure-volume relation at end-diastolic. E n (t n ) represents the normalized function of ventricular elasticity, which is described as the Hill equation as follows(18): where t n is t/T max , and the T max can be calculated from the cardiac cycle: …”

Bicuspid aortic valve associated aortopathy: 2022 guideline update

“…Although most patients with BAV are not found to have a genetic variant, certain types of heritable thoracic aortic diseases (HTAD) demonstrate a high prevalence of BAV. These include Loeys-Dietz syndrome (TGFBT1, TGFBR2, SMAD3, TGFB2, TGFB3 mutations), and other variants involving the NOTCH1, ACTA2, MAT2A, SMAD6 and LOX genes [32 ▪▪ ]. Inherent defects in vessel wall integrity have been proposed in the pathogenesis of BAV aortopathy.…”

“…The rate is also influenced by the baseline dimension, and tends to be progress at a higher rate as aortic dimensions increase. The ‘hinge point’ or threshold when the risk of aortic dissection increases has been estimated to be >5.25–5.75 cm [32 ▪▪ ]. Those with BAV and no significant dilatation of the ascending aorta remain at very low risk of aortic dissection.…”

Effects of cardiac function alterations on the risk of postoperative thrombotic complications in patients receiving endovascular aortic repair

“…Abdominal aortic aneurysm (AAA) is one of the most common degenerative aortic diseases and is often complicated with various levels of cardiac dysfunction and cardiovascular comorbidities ( Lim et al, 2015 ). For advanced and/or rapid-growing aneurysms, prompt surgical or endovascular interventions are indicated, among which endovascular aortic aneurysm repair (EVAR) is widely accepted as the first-line treatment option for anatomically feasible cases ( Isselbacher et al, 2022 ). Cardiac comorbidities may increase the risk of perioperative surgical complications and affect mid-to-long-term prognosis ( Khashram et al, 2016 ).…”