Cited by 2,082Aortic Disease and Treatment ApproachesConnective tissue disorders researchAortic aneurysm repair treatments

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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

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Isselbacher, Eric M., Preventza, Ourania, Hamilton Black, James, Augoustides, John G., Beck, Adam W., Bolen, Michael A., Braverman, Alan C., Bray, Bruce E., Brown-Zimmerman, Maya M., Chen, Edward P., Collins, Tyrone J., DeAnda, Abe, Fanola, Christina L., Girardi, Leonard N., Hicks, Caitlin W., Hui, Dawn S., Schuyler Jones, William, Kalahasti, Vidyasagar, Kim, Karen M., Milewicz, Dianna M., Oderich, Gustavo S., Ogbechie, Laura, Promes, Susan B., Gyang Ross, Elsie, Schermerhorn, Marc L., Singleton Times, Sabrina, Tseng, Elaine E., Wang, Grace J., Woo, Y. Joseph, Faxon, David P., Upchurch, Gilbert R., Aday, Aaron W., Azizzadeh, Ali, Boisen, Michael, Hawkins, Beau, Kramer, Christopher M., Luc, Jessica G.Y., MacGillivray, Thomas E., Malaisrie, S. Christopher, Osteen, Kathryn, Patel, Himanshu J., Patel, Parag J., Popescu, Wanda M., Rodriguez, Evelio, Sorber, Rebecca, Tsao, Philip S., Santos Volgman, Annabelle·2022·Circulation

DOI 10.1161/cir.0000000000001106PMC PMC9876736

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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.

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Firwana, M., Hasan, B., Saadi, S., Abd-rabu, R., Alabdallah, K., Alzu'bi, H., Shalhub, S., Black, J., Prokop, L., & Murad, M. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.06.004 · Cited by 8
Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis
Song, W., Liu, J., Tu, G.-W., Pan, L., Hong, Y., Qin, L., Wei, L., & Chen, J. (2023) · BMC Cardiovascular Disorders · doi:10.1186/s12872-023-03517-z · Cited by 10
Risk Factors for Spinal Cord Injury during Endovascular Repair of Thoracoabdominal Aneurysm: Review of the Literature and Proposal of a Prognostic Score
Brisard, L., Batti, S. E., Borghese, O., & Maurel, B. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12247520 · Cited by 10
Blood Pressure Management for Hypotensive Patients in Intensive Care and Perioperative Cardiovascular Settings
Kotani, Y., Ursoleo, J. D., Murru, C. P., & Landoni, G. (2024) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2024.04.010 · Cited by 10
Pre-emptive False Lumen Embolization to Prevent Persistent Type II Endoleak in Fenestrated-Branched Endovascular Repair of Post-Dissection Thoracoabdominal Aortic Aneurysms
Gallitto, E., Faggioli, G., Poliseno, C., Cappiello, A., Pini, R., Vacirca, A., Logiacco, A. M., & Gargiulo, M. (2024) · Journal of Endovascular Therapy · doi:10.1177/15266028241246656 · Cited by 10
Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection
Ogami, T., Arnaoutakis, G. J., Isselbacher, E. M., Geuzebroek, G. S. C., Coselli, J. S., Vincentiis, C. D., Kaiser, C. A., Hutchison, S., Li, Q., Brinster, D. R., et al. (2024) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2024.03.029 · Cited by 10
Layer-specific biomechanical and histological properties of normal and dissected human ascending aortas
Guo, X., Yu, H., Wang, L., Zhai, Y., Li, J., Tang, D., & Sun, H. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e34646 · Cited by 10
Impact of osteoporosis on overall survival following endovascular repair for abdominal aortic aneurysms
Ozawa, H., Ohki, T., Shukuzawa, K., Nakamura, K., Nishide, R., Kasa, K., Nakagawa, H., Shirouzu, M., Omori, M., & Fukushima, S. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.08.034 · Cited by 10
Next-Generation Frozen Elephant Trunk Technique in the Era of Precision Medicine
Song, S., Lee, H., Kim, M.-S., Wong, R. H. L., Ho, J. Y. K., Szeto, W. Y., & Jakob, H. G. (2024) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/jcs.24.089 · Cited by 10
Baseline Diameter Does Not Predict Growth Rate in a Presurgical Ascending Thoracic Aortic Aneurysm Population
Marway, P. S., Tjahjadi, N., Figueroa, C. A., Knauer, H. A., Spahlinger, G., Masotti, M., Eagle, K. A., Bowman, M. A. H., Patel, H. J., & Burris, N. S. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.124.036896 · Cited by 10
Artificial intelligence-powered solutions for automated aortic diameter measurement in computed tomography: a narrative review
Lo, E. M. K., Chen, S., Ng, K. H. L., & Wong, R. H. L. (2024) · Annals of Translational Medicine · doi:10.21037/atm-24-171 · Cited by 10
Systematic Review and Meta-analysis of Outcomes of the Advanta V12 or iCAST Bridging Stent Graft Used for Fenestrated and Branched Endovascular Aortic Repair
Nana, P., Dakis, K., Brotis, A. G., Torrealba, J. I., Panuccio, G., Spanos, K. T., & Kölbel, T. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.01.004 · Cited by 10
The protective role of SGLT2 inhibitors on aortic aneurysm mediated by oxidative stress and inflammation in type 2 diabetes mellitus
Zheng, R., Song, W., Lu, J. L., Yuan, M., Sun, X., & Lu, C. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-025-02600-3 · Cited by 11
The TRPM7 chanzyme in smooth muscle cells drives abdominal aortic aneurysm in mice
Wang, X., Wang, M., Zhu, T.-T., Zheng, Z.-J., Li, S., Sui, Z.-Y., Guo, X., Wu, S., Zhang, N.-N., Yu, Z., et al. (2025) · Nature Cardiovascular Research · doi:10.1038/s44161-025-00613-5 · Cited by 10
Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality among hypertension patients
Su, X., Rao, H., Zhao, C., Wu, J., Zhang, X., & Li, D. (2025) · Scientific Reports · doi:10.1038/s41598-025-88539-7 · Cited by 10
The Role of 4D Flow MRI-derived Wall Shear Stress in Aortic Disease: A Comprehensive Review
Liu, Y., Mu, X., Wang, Y., Xu, Z., & Song, Y. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm26735 · Cited by 10
Lp(a): A Clinical Review
Anchouche, K., Baass, A. W., & Thanassoulis, G. (2025) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2025.110929 · Cited by 11
2025 ACC/AHA Clinical Practice Guidelines Core Principles and Development Process: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Otto, C. M., Abdullah, A. R., Davis, L. L., Ferrari, V. A., Fremes, S. E., Mukherjee, D., Prestera, L., & Ziaeian, B. (2025) · Circulation · doi:10.1161/cir.0000000000001383 · Cited by 12
The Fate of Patients Opportunistically Screened for Abdominal Aortic Aneurysms During Echocardiogram or Arterial Duplex Scans
Chiew, K., Roy, I. N., Budge, J., D’Abate, F., Holt, P., & Loftus, I. M. (2023) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2023.05.042 · Cited by 10
Global research status analysis of the association between aortic aneurysm and inflammation: a bibliometric analysis from 1999 to 2023
Wang, Q., Chen, G., Qi, Z., Zeng, Y., Tan, L., & Tang, H. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1260935 · Cited by 11
Five Year Results of Endovascular versus Medical Therapy in Acute Type B Aortic Intramural Haematoma: Meta-Analysis of Reconstructed Time to Event Data
Sá, M. P., Jacquemyn, X., Tasoudis, P., Dufendach, K., Singh, M. J., de la Cruz, K. I., Serna-Gallegos, D. R., & Sultan, I. S. (2023) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2023.12.024 · Cited by 10
Multiyear Interval Changes in Aortic Wall Shear Stress in Patients with Bicuspid Aortic Valve Assessed by 4D Flow MRI
Maroun, A., Scott, M., Catania, R., Berhane, H., Jarvis, K., Allen, B. D., Barker, A. J., & Markl, M. (2024) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.29305 · Cited by 10
Five-year sex-related outcomes of thoracic endovascular aortic repair in the Global Registry for Endovascular Aortic Treatment
Lomazzi, C., Mandigers, T. J., Gargiulo, M., Mascoli, C., Piffaretti, G., Upchurch, G. R., & Trimarchi, S. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.05.027 · Cited by 10
Molecular genetic characterization of sudden deaths due to thoracic aortic dissection or rupture
Saxton, S., Dickinson, G., Wang, D., Zhou, B., Um, S. Y., Lin, Y. L., Rojas, L., Sampson, B. A., Graham, J. K., & Tang, Y. (2023) · Cardiovascular Pathology · doi:10.1016/j.carpath.2023.107540 · Cited by 9
Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta
You, Y. J., & Ko, S. M. (2023) · Korean Journal of Radiology · doi:10.3348/kjr.2023.0312 · Cited by 10
Frozen elephant trunk in acute aortic dissection: a literature review
Murana, G., Campanini, F., Orioli, V., Pagano, V., Santamaria, V., Marco, L. D., Bartolomeo, R. D., & Pacini, D. (2023) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-023-01624-2 · Cited by 9
Thoracoabdominal aortic aneurysm in women: many questions remain regarding their poor outcome
Borghese, O., & Mastracci, T. M. (2023) · Annals of Cardiothoracic Surgery · doi:10.21037/acs-2022-adw-0119 · Cited by 9
Systematic Review and Meta-analysis of Short-term and Mid-term Outcomes After Use of t-Branch Off-the-shelf Multibranched Endograft for Elective and Urgent Treatment of Thoracoabdominal Aortic Aneurysms
Chen, Y., Liu, Z., Wang, S., D’Oria, M., Zhang, X., Bi, J., Cui, D., & Dai, X. (2023) · Journal of Endovascular Therapy · doi:10.1177/15266028231220322 · Cited by 9
Extended thoracic endovascular aortic repair is optimal therapy in acute complicated type B dissection
Nissen, A. P., Huckaby, L. V., Duwayri, Y. M., Jordan, W. D., Farrington, W. J., Keeling, W. B., & Leshnower, B. G. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.05.009 · Cited by 9
Management strategies and outcomes in pregnancy-related acute aortic dissection: a multicentre cohort study in China
Liu, H., Liu, Y., Chen, C., Qian, S.-C., Ma, L.-Y., Diao, Y., Wu, X.-Y., Wu, S., Dong, Z.-Q., Shao, Y.-F., et al. (2024) · Heart · doi:10.1136/heartjnl-2024-324009 · Cited by 9
Elective root replacement increases the risk of type B dissection in patients with Marfan syndrome
Thomas, R., Dhanekula, A., Byers, P. H., Flodin, R., DeRoo, S. C., Shalhub, S., & Burke, C. R. (2024) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2024.09.027 · Cited by 9
Interplay of atherosclerosis and medial degeneration in human ascending aorta
Huhta, A., Paavonen, T., Mennander, A., & Kholová, I. (2024) · Cardiovascular Pathology · doi:10.1016/j.carpath.2024.107702 · Cited by 9
Machine Learning Model for Predicting Risk Factors of Prolonged Length of Hospital Stay in Patients with Aortic Dissection: a Retrospective Clinical Study
Li, L., Chen, Y., Xie, H., Zheng, P., Mu, G., Li, Q., Huang, H., & Shen, Z. (2024) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-024-10565-z · Cited by 9
Procedural Volume and Outcomes After Septal Reduction Therapies in Hypertrophic Obstructive Cardiomyopathy
Patel, N. B., Shetty, N. S., Gaonkar, M. P., Shahid, A., Divekar, G., Pampana, A., Vekariya, N., Li, P., Ahmed, M. I., Arora, G., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.124.036387 · Cited by 10
Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States
Goyal, A., Saeed, H., Shamim, U., Siddiqui, M. R., Abdullah, A., Arshad, M. K., Jain, H., Daoud, M., Khan, R., & Bansal, K. (2024) · International Journal of Surgery · doi:10.1097/js9.0000000000002150 · Cited by 9
All-cause mortality and death by aortic dissection in women with Turner syndrome: A national clinical cohort study
Thunström, S., Thunström, E. Ö., Naessén, S., Berntorp, K. E., Kitlinski, M. L., Ekman, B., Wahlberg, J., Bergström, I. B., Isaksson, M., Basic, C., et al. (2024) · American Heart Journal · doi:10.1016/j.ahj.2024.11.007 · Cited by 9
Recommendations for Design, Execution, and Reporting of Studies on Experimental Thoracic Aortopathy in Preclinical Models
Daugherty, A., Milewicz, D. M., Dichek, D. A., Ghaghada, K. B., Humphrey, J. D., LeMaire, S. A., Li, Y., Mallat, Z., Saeys, Y., Sawada, H., et al. (2025) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.124.320259 · Cited by 11
Anatomy-derived 3D Aortic Hemodynamics Using Fluid Physics–informed Deep Learning
Berhane, H., Maroun, A., Dushfunian, D., Baraboo, J. J., Martinez, G., Jacobson, T., Bağcı, U., Allen, B. D., & Markl, M. (2025) · Radiology · doi:10.1148/radiol.240714 · Cited by 9
The Expanding Genetic Architecture of Arteriopathies: From Canonical TAAD Genes to Emerging Connective Tissue and Signaling Pathways
Dreher, L. A., Nabi, H. A., VanDolah, H. B., Brennan, S., Bcharah, G., Bcharah, H., Osundiji, M. A., Baudhuin, L. M., & Shamoun, F. E. (2025) · Medical Sciences · doi:10.3390/medsci13030155 · Cited by 10
“…TGF-β pathway genes on clinical panels is supported by their strong penetrance and clinical utility in guiding early surgical intervention, with the 2022 AHA/ACC guidelines recommending prophylactic repair at 4.0–4.5 cm in individuals with TGFBR1, TGFBR2, SMAD3, TGFB2, or TGFB3 variants [19,102].”
Influential
AI-driven decision making for intravascular device selection in aortic disease. Current insights and prospects
Dinç, R., & Ardıç, N. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1585299 · Cited by 10
Calcium channel blockers increase the risk of aortic aneurysm and dissection
Ma, T., Cai, Z., Xu, X., Cao, L., Wang, A., Zhang, Z., Zhang, S. J., Huang, Z., Luo, J., Lin, S., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-68086-5 · Cited by 9
Cellular Heterogeneity in Aortic Aneurysm and Dissection: Molecular Mechanisms and Therapeutic Opportunities
Song, T., Han, Y., Xie, L. P., & Ji, Y. (2026) · Circulation Research · doi:10.1161/circresaha.125.327197 · Cited by 9
The D-Dimer to Troponin Ratio Is a Novel Marker for the Differential Diagnosis of Thoracic Acute Aortic Syndrome from Non-ST Elevation Myocardial Infarction
Lee, M., Kim, Y. W., Lee, D., Kim, T. Y., Lee, S., Seo, J. S., & Lee, J. H. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093054 · Cited by 9
Natural history of aortic root dilatation and pathologic aortic regurgitation in tetralogy of Fallot and its morphological variants
Sengupta, A., Lee, J. M., Gauvreau, K., Colan, S. D., del Nido, P. J., Mayer, J. E., & Nathan, M. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.04.014 · Cited by 9
The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta
Hamiko, M., Jahnel, K., Rogaczewski, J., Schafigh, M., Silaschi, M., Spaeth, A., Velten, M., Roell, W., Ahmad, A., & Bakhtiary, F. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134498 · Cited by 9
Possible implications of device-specific variability in post-endovascular aneurysm repair sac regression and endoleaks for surveillance categorization
Väärämäki, S., Uurto, I. T., & Suominen, V. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.07.001 · Cited by 9
Reproductive decision‐making and the utilization of preimplantation genetic testing among individuals with inherited aortic or vascular disease
Patton, K., Wong, E., Cirino, A. L., Dobson, L. J., & Harris, S. L. (2023) · Journal of Genetic Counseling · doi:10.1002/jgc4.1759 · Cited by 9
Anatomic feasibility of a modular Endo-Bentall stent graft system for type A aortic dissection
Rong, D., Chen, X., Han, J., Yin, J., Ge, Y., Liu, F., & Guo, W. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.07.062 · Cited by 9
Longitudinal versus circumferential biomechanical behavior of the aneurysmal ascending aorta
Kramer, B., Thompson, M. A., Tarraf, S. A., Vianna, E., Gillespie, C. M., Germano, E., Gentle, B., Cikach, F. S., Lowry, A. M., Pande, A., et al. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.09.016 · Cited by 9
Acute-on-Chronic Aortic Dissection: Management and Outcomes of the Unstable “Triple-Lumen” Aorta
Norton, E. L., Farrington, W. J., Keeling, W. B., Wei, J. W., Binongo, J., Zellner, A. B., Chen, E. P., & Leshnower, B. G. (2023) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2023.10.029 · Cited by 9
Type III aortic arch angulation increases aortic stiffness: Analysis from an ex vivo porcine model
Mandigers, T. J., Pascaner, A. F., Conti, M., Schembri, M., Jelic, S., Favilli, A., Bissacco, D., Domanin, M., van Herwaarden, J. A., Auricchio, F., et al. (2023) · JTCVS Open · doi:10.1016/j.xjon.2023.10.035 · Cited by 9
Three-dimensional aortic geometry mapping via registration of non-gated contrast-enhanced or gated and respiratory-navigated MR angiographies
Dux‐Santoy, L., Rodríguez-Palomares, J. F., Teixidó‐Turà, G., Garrido-Oliver, J., Carrasco-Poves, A., Morales-Galán, A., Ruiz‐Muñoz, A., Casas, G., Valente, F. X., Galián-Gay, L., et al. (2024) · Journal of Cardiovascular Magnetic Resonance · doi:10.1016/j.jocmr.2024.100992 · Cited by 9
“…diameters were measured manually after double-oblique multiplanar reconstructions in the ascending (AscAo) and descending (DescAo) aorta at the level of the pulmonary bifurcation, and in the DescAo at the level of diaphragm, following the inner-to-inner edge convention, as recommended [3,19].”
Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs
Palmieri, V., Vietri, M. T., Montalto, A., Montisci, A., Donatelli, F., Coscioni, E., & Claudio Napoli, A. (2023) · Cancers · doi:10.3390/cancers15082224 · Cited by 9
Clinical characteristics and outcomes in patients with acute type A aortic intramural hematoma
Kanagami, T., Saito, Y., Hashimoto, O., Nakayama, T., Okino, S., Sakai, Y., Nakamura, Y., Fukuzawa, S., Himi, T., & Kobayashi, Y. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131355 · Cited by 8
Nadir oxygen delivery during cardiopulmonary bypass in acute type A aortic dissection repair
Peng, Q., Cai, M., Chen, X., Lin, T., Meng, W., Guan, L., Zhu, P., Zheng, S., Lu, J., & Zhou, P. (2023) · Journal of Thoracic Disease · doi:10.21037/jtd-23-561 · Cited by 8
“One hundred seventy-eight patients who met the ATAAD diagnostic criteria in 2022 ACC/AHA Guidelines for the Diagnosis and Management of Aortic Diseases (10) and underwent emergent ATAAD repair (Sun’s procedure) under CPB were enrolled in this study.”
“Big Data” Analyses Underlie Clinical Discoveries at the Aortic Institute
Zafar, M. A., Ziganshin, B. A., Li, Y., Ostberg, N. P., Rizzo, J. A., Tranquilli, M., Mukherjee, S. K., & Elefteriades, J. A. (2023) · The Yale Journal of Biology and Medicine · doi:10.59249/lndz2964 · Cited by 8
The Impact of Pregnancy in Patients with Thoracic Aortic Disease: Epidemiology, Risk Assessment, and Management Considerations
Duarte, V. E., Richardson, J. N., & Singh, M. N. (2024) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcvj.1371 · Cited by 9
Artificial Intelligence Provides Accurate Quantification of Thoracic Aortic Enlargement and Dissection in Chest CT
Fink, N., Yacoub, B., Schoepf, U. J., Zsarnóczay, E., Pinos, D., Vecsey-Nagy, M., Rapaka, S., Sharma, P. K., O’Doherty, J., Ricke, J., et al. (2024) · Diagnostics · doi:10.3390/diagnostics14090866 · Cited by 8
The role of cardiac surgeons in transcatheter structural heart disease interventions: The evolution of cardiac surgery
Pirelli, L., Grubb, K. J., George, I., Goldsweig, A. M., Nazif, T. M., Dahle, G., Myers, P. O., Ouzounian, M., Szeto, W. Y., Maisano, F., et al. (2024) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2024.10.037 · Cited by 8
Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of Type B aortic dissection
Messou, J. C. E., Yeung, K., Sudbrook, E., Zhang, J. M., Toursavadkohi, S. A., Ucuzian, A. A., & Tubaldi, E. (2024) · Scientific Reports · doi:10.1038/s41598-024-78348-9 · Cited by 8
Safety of prolonged bilateral antegrade cerebral perfusion in aortic arch surgery with moderate hypothermia
Hohri, Y., Rajesh, K., Murana, G., Castagnini, S., Bianco, E., Zhao, Y., Kurlansky, P. A., Pacini, D., & Takayama, H. (2024) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezae459 · Cited by 8
Enhanced Vascular Smooth Muscle Cell and Extracellular Matrix Repair Using a Metal‐Organic Framework‐Based Co‐Delivery System for Abdominal Aortic Aneurysm Therapy
Lei, J., Dong, X., Huang, Y. Z., Wu, Z., Peng, Z., Li, B., Wang, R., Pan, Y., Zheng, X., Zhao, Z., et al. (2024) · Advanced Healthcare Materials · doi:10.1002/adhm.202402937 · Cited by 8
Comparison of short-and long-term outcomes between endovascular and open repair for descending thoracic aortic aneurysm: a systematic review and meta-analysis
Liu, J., Gou, D., Xu, K., Lu, Z., Li, P., Lei, Y. H., Wang, Y., Yang, Y., Liu, S., & Zhu, G. (2025) · International Journal of Surgery · doi:10.1097/js9.0000000000002230 · Cited by 8
Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study
Fleischmann, D., Mastrodicasa, D., Willemink, M. J., Turner, V. L., Hinostroza, V., Burris, N. S., Yang, B., Hanneman, K. A., Ouzounian, M., Trujillo, D. O., et al. (2025) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.124.016766 · Cited by 8
Myeloid Cells in Abdominal Aortic Aneurysm
Yang, W., Li, F., Zheng, Y.-H., & Wang, L. (2025) · Current Atherosclerosis Reports · doi:10.1007/s11883-025-01302-1 · Cited by 10
Sex- and region-specific differences in microstructural remodeling and passive biomechanics of the aorta correlate with aneurysm propensity in a mouse model of severe Marfan syndrome
Dwivedi, K. K., Wu, Y., Rother, J., & Wagenseil, J. E. (2025) · Acta Biomaterialia · doi:10.1016/j.actbio.2025.05.056 · Cited by 9
TEVAR Versus Optimal Medical Therapy for Uncomplicated Type B Aortic Dissection: A Systematic Review & Meta-analysis
Jubouri, M., Surkhi, A. O., Alsarayrah, A. I., Alaraj, R. S. N., Campbell, D. I., Qaisi, A. F., Andonie, C. R., Jubouri, Y. F., Abdelhaliem, A., Piffaretti, G., et al. (2025) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2025.06.020 · Cited by 8
Exploring thoracic aorta ECM alterations in Marfan syndrome: insights into aorta wall structure
de Souza, R. B., Cassiano, L. L., Barnowski, P., Ventura, S., Turato, W. M., Nascimento, S. C. R., Mignanelli, G. L., Caldeira, W., Martins, A. M. C. R. P. D. F., Luposeli, F. D. C., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-09665-w · Cited by 8
Global, regional, and national burden of aortic aneurysm disease and its attributable risk factor, 1990–2021: a systematic analysis for the global burden of disease study 2021
Zhuo, Y., Zhao, D., Luo, M., Zhou, Z., & Shu, C. (2025) · Internal and Emergency Medicine · doi:10.1007/s11739-025-04061-8 · Cited by 8
Perivascular inflammation in the progression of aortic aneurysms in Marfan syndrome
Sowa, H., Yagi, H., Ueda, K., Hashimoto, M., Karasaki, K., Liu, Q., Kurozumi, A., Adachi, Y., Yanase, T., Okamura, S., et al. (2025) · JCI Insight · doi:10.1172/jci.insight.184329 · Cited by 8
A wireless, implantable sensor for continuous monitoring of blood leakage after endovascular aneurysm repair
Park, S. Y., Kim, S. H., Baik, U., Huh, S. J., Avila, R. O., Shin, H. H., Yoo, H., Shin, H., Kim, J., Lim, Y., et al. (2025) · Science Advances · doi:10.1126/sciadv.ady6148 · Cited by 8
MR Angiography for Aortic Diseases
Garg, I., Grist, T. M., & Nagpal, P. (2023) · Magnetic Resonance Imaging Clinics of North America · doi:10.1016/j.mric.2023.05.002 · Cited by 8
Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies
Qin, J., Ouyang, D., Yan, T., Wang, H., Guo, K., Jin, X., Pan, Z., & He, L. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1131025 · Cited by 8
Early clinical outcomes and molecular smooth muscle cell phenotyping using a prophylactic aortic arch replacement strategy in Loeys-Dietz syndrome
Pedroza, A. J., Cheng, P. P., Dalal, A. R., Bäumler, K., Kino, A., Tognozzi, E., Shad, R., Yokoyama, N., Nakamura, K., Mitchel, O. R., et al. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.07.023 · Cited by 8
Contemporary Evaluation and Clinical Treatment Options for Aortic Regurgitation
Lebehn, M. A., Vahl, T. P., Kampaktsis, P. Ν., & Hahn, R. T. (2023) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd10090364 · Cited by 9
“The 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease provides recommendations on the timing of imaging, timing of intervention depending upon aortic size in speciﬁc disease states, and recommendations on indexing to the patients’ BSA or height [16].”
Method
Staging TEVAR after FET — an exception or the rule?
Marco, L. D., Nocera, C., Snaidero, S., Campanini, F., Buia, F., Lovato, L., Murana, G., & Pacini, D. (2023) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-023-01611-7 · Cited by 8
Natural history of the distal aorta following elective root replacement in patients with Marfan syndrome
Dhanekula, A., Flodin, R., Shibale, P., Volk, J., Benyakorn, T., DeRoo, S. C., Shalhub, S., & Burke, C. R. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.10.061 · Cited by 8
The Complementary Roles of Open and Endovascular Repair of Extent I – III Thoraco-abdominal Aortic Aneurysms in a United Kingdom Aortic Centre
Adam, D. J., Juszczak, M. T., Vezzosi, M., Claridge, M., Quinn, D. W., Senanayake, E. L., Clift, P., & Mascaro, J. G. (2024) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2024.02.031 · Cited by 8
Vascular Endothelial Growth Factor Inhibitors and the Risk of Aortic Aneurysm and Aortic Dissection
Wu, C., Huang, H., Lin, S., Wang, C., Huang, C., & Wu, I. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.0940 · Cited by 8
Multimodality imaging to assess diagnosis and evaluate complications of large vessel arteritis
Aghayev, A., Weber, B., de Carvalho, T. L., Glaudemans, A. W. J. M., Nienhuis, P. H., van der Geest, K. S. M., & Slart, R. H. J. A. (2024) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2024.101864 · Cited by 8
Congenital heart diseases (CHDs) and forensic investigations: Searching for the cause of death
Sessa, F., Chisari, M. G., Salerno, M., Esposito, M., Zuccarello, P., Capasso, E., Scoto, E., & Cocimano, G. (2024) · Experimental and Molecular Pathology · doi:10.1016/j.yexmp.2024.104907 · Cited by 11
Sex-based disparities in ascending aortic aneurysm surgery outcomes: a comprehensive analysis of 1148 consecutive patients with propensity-score matching
Al‐Tawil, M., Friedrich, C., Broll, A., Salem, M., Schoettler, J., Silva, N., Kolat, P., Schoeneich, F., & Haneya, A. (2024) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-024-02646-6 · Cited by 8
“The established threshold for surgical referral in patients with AscAA is a maximum aortic diameter > 55 mm [9, 10].”
BackgroundInfluential
Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study
Fujiwara, T., Malone, L. J., Chatfield, K. C., Berthusen, A. J., Fonseca, B., Browne, L. P., & Barker, A. J. (2024) · Journal of Cardiovascular Magnetic Resonance · doi:10.1016/j.jocmr.2024.101102 · Cited by 8
“Given the need to monitor the rate of aortic dilation and a higher risk of aortic dissection, lifelong imaging surveillance is recommended in adults who have aortic root, AAo, or both greater than 4.0 cm in diameter [2,3].”
Influential
Prognosis of Unrepaired Ascending Aorta after the Surgical Replacement of Bicuspid Aortic Valves
Shin, H. J., Kim, W. K., Kim, D. K., Kim, H. J., & Kim, J. B. (2023) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/jcs.23.007 · Cited by 8
Contemporary outcomes of open repair of acute complicated type B aortic dissection
Lau, C., Soletti, G. J., Lawrence, K. M., Rahouma, M., Iannacone, E., Gambardella, I., Gaudino, M. F. L., & Girardi, L. N. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.04.042 · Cited by 8
Macrophage scavenger receptor A1 antagonizes abdominal aortic aneurysm via upregulating IRG1
Huang, J., Jiang, Y., Ji, R., Jia, Y., Wang, S., Zhou, Z., Wang, S., Wang, J., Yang, Q., Bai, H., et al. (2023) · Biochemical Pharmacology · doi:10.1016/j.bcp.2023.115631 · Cited by 9
Challenges and Opportunities in Aortic Dissection: The Journey to Personalized Medicine
Bowman, M. A. H., & Eagle, K. A. (2024) · Circulation · doi:10.1161/circulationaha.124.071088 · Cited by 8
Hereditary Thoracic Aortic Diseases
Spaziani, G., Surace, F. C., Girolami, F., Bianco, F., Bucciarelli, V., Bonanni, F., Bennati, E., Arcieri, L., & Favilli, S. (2024) · Diagnostics · doi:10.3390/diagnostics14010112 · Cited by 7
“All women with HTAD should undergo pre-conceptional counselling from adolescence about the risks of aortic dissection related to pregnancy, and appropriate aortic imaging with transthoracic echocardiography, cardiac magnetic resonance or computed tomography is recommended [5].”
BackgroundInfluential
The perspective of cAMP/cGMP signaling and cyclic nucleotide phosphodiesterases in aortic aneurysm and dissection
Shu, T., Zhou, Y., & Chen, Y. (2024) · Vascular Pharmacology · doi:10.1016/j.vph.2024.107278 · Cited by 7
Ten-year single-center outcomes following endovascular repair for abdominal aortic aneurysm using the INCRAFT device
Ozawa, H., Ohki, T., Shukuzawa, K., Kasa, K., Yamada, Y., Nakagawa, H., Shirouzu, M., Omori, M., Fukushima, S., & Tachihara, H. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.03.015 · Cited by 7
Surveillance of adults with congenital heart disease: Current guidelines and actual clinical practice
Roos‐Hesselink, J. W., Pelosi, C., Brida, M., Backer, J. F. A. D., Ernst, S., Budts, W., Baumgartner, H., Oechslin, E. N., Tobler, D., Kovacs, A. H., et al. (2024) · International Journal of Cardiology · doi:10.1016/j.ijcard.2024.132022 · Cited by 7
Aneurysm sac shrinkage at 1 year after fenestrated-branched endovascular aortic repair of complex aortic aneurysms offers mid-term survival advantage
Mésnard, T., Sulzer, T. A. L., Kanamori, L. R., Babocs, D., Vacirca, A., Baghbani‐Oskouei, A., Savadi, S., Tenorio, E. R., Mirza, A. K., Saqib, N. U., et al. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.05.054 · Cited by 7
Natural history and long-term outcomes of medically managed Type B intramural hematoma
Vaddavalli, V. V., Wilkins, P., Schaller, M. S., Morrison, J. J., Shuja, F., Colglazier, J. J., Mendes, B. C., Rasmussen, T. E., Kalra, M., & DeMartino, R. R. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.04.069 · Cited by 7
Identification of Variants of Uncertain Significance in the Genes Associated with Thoracic Aortic Disease in Russian Patients with Nonsyndromic Sporadic Subtypes of the Disorder
Goncharova, I. A., Shipulina, S. А., Sleptcov, A. A., Зарубин, А. А., Valiakhmetov, N. R., Панфилов, Д. С., Lelik, E. V., Саушкин, В. В., Kozlov, B. N., Назаренко, Л. П., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25158315 · Cited by 7
“Therefore, we should keep patients with a VUS under observation including periodic imaging of the aorta starting from when the genetic variant was identified until the diagnosis is finally confirmed or refuted [19].”
BackgroundMethod
Acute aortic syndrome
Goodacre, S. W., Lechêne, V., Cooper, G. J., Wilson, S., & Zhong, J. (2024) · BMJ · doi:10.1136/bmj-2024-080870 · Cited by 7
Identification of Genetic Variants Associated with Hereditary Thoracic Aortic Diseases (HTADs) Using Next Generation Sequencing (NGS) Technology and Genotype–Phenotype Correlations
Butnariu, L. I., Russu, G., Luca, A.-C., Sandu, C., Trandafir, L. M., Vasiliu, I., Popa, S., Ghiga, G., Bălănescu, L., & Țarcă, E. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252011173 · Cited by 7
“In the case of identification of a pathogenic/likely pathogenic variant, genetic testing and aortic imaging of biological relatives at risk are recommended [4].”
BackgroundInfluential

Authors: Isselbacher, E. M., Preventza, O., Hamilton Black, J., Augoustides, J. G., Beck, A. W., Bolen, M. A., Braverman, A. C., Bray, B. E., Brown-Zimmerman, M. M., Chen, E. P., Collins, T. J., DeAnda, A., Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Schuyler Jones, W., Kalahasti, V., Kim, K. M., Milewicz, D. M., Oderich, G. S., Ogbechie, L., Promes, S. B., Gyang Ross, E., Schermerhorn, M. L., Singleton Times, S., Tseng, E. E., Wang, G. J., Woo, Y. J., Faxon, D. P., Upchurch, G. R., Aday, A. W., Azizzadeh, A., Boisen, M., Hawkins, B., Kramer, C. M., Luc, J. G. Y., MacGillivray, T. E., Malaisrie, S. C., Osteen, K., Patel, H. J., Patel, P. J., Popescu, W. M., Rodriguez, E., Sorber, R., Tsao, P. S., & Santos Volgman, A.
Affiliations: SCA representative.
ACR representative.
American Heart Association (US)
Lay stakeholder representative.
Fraunhofer Institute for Algorithms and Scientific Computing (DE)
AATS representative.
American Hospital Association (US)
AHA/ACC Joint Committee on Clinical Practice Guidelines liaison.
STS representative.
SVS representative.
AHA/ACC staff representative.
ORCID: Isselbacher, Eric M.
Preventza, Ourania
Augoustides, John G.
Beck, Adam W.
Bolen, Michael A.
Braverman, Alan C.
Bray, Bruce E.
Chen, Edward P.
DeAnda, Abe
Fanola, Christina L.
Girardi, Leonard N.
Hicks, Caitlin W.
Hui, Dawn S.
Kalahasti, Vidyasagar
Kim, Karen M.
Milewicz, Dianna M.
Oderich, Gustavo S.
Promes, Susan B.
Schermerhorn, Marc L.
Tseng, Elaine E.
Upchurch, Gilbert R.
Aday, Aaron W.
Azizzadeh, Ali
Boisen, Michael
Kramer, Christopher M.
Luc, Jessica G.Y.
MacGillivray, Thomas E.
Osteen, Kathryn
Patel, Himanshu J.
Patel, Parag J.
Popescu, Wanda M.
Sorber, Rebecca
Tsao, Philip S.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2022-12-13
Volume: 146
Issue: 24
Pages: e334-e482
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/cir.0000000000001106
PMC: PMC9876736
OpenAlex: W4307934708
Cited by: 2,082
References: 1,104
Citations by year: 2026: 600 · 2025: 569 · 2024: 554 · 2023: 348 · 2022: 9
FWCI: 239.09
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
Locations: Circulation (publishedVersion, cc-by)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Veterans Affairs
American Heart Association
Massachusetts General Hospital
American College of Cardiology Foundation
University of Pennsylvania
CryoLife
Office of Science
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124515)
Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Anschutz Medical Campus
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
Health Sciences › Medicine › Surgery › Aortic aneurysm repair treatments
Keywords: aortic disease, thoracic aortic disease, acute aortic syndrome, aortic aneurysm, aortic dissection, bicuspid aortic valve disease, peripheral arterial disease, genetic evaluation, family screening, endovascular repair, aortic surgery, long-term surveillance, shared decision-making, pregnancy
MeSH terms: Bicuspid Aortic Valve Disease, American Heart Association, Aortic Diseases, Cardiology, Female, Humans, Pregnancy, United States, Research Report

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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

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