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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Abdominal Aortic Aneurysm in Marfan Syndrome
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Zone zero hybrid arch exclusion versus open total arch replacement
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Gender-related outcomes after open repair of descending thoracic and thoracoabdominal aortic aneurysms
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Late magnetic resonance surveillance of repaired coarctation of the aorta☆☆☆
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Design of new patient-reported outcome measures to assess quality of life, symptoms and treatment satisfaction in patients with abdominal aortic aneurysm
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Are outcomes of thoracoabdominal aortic aneurysm repair different in men versus women? A propensity-matched comparison
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Identification of novel genetic susceptibility loci for thoracic and abdominal aortic aneurysms via genome-wide association study using the UK Biobank Cohort
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Outcomes of thoracic endovascular aortic repair in adult coarctation patients
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Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians
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Management of acute type A intramural hematoma: upfront surgery or individualized approach? A retrospective analysis and meta-analysis
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Aortic Neck IFU Violations During EVAR for Ruptured Infrarenal Aortic Aneurysms are Associated with Increased In-Hospital Mortality
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Treatment of primary infected aortic aneurysm without aortic resection
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The aortic root does not dilate over time after replacement of the aortic valve and ascending aorta in patients with bicuspid or tricuspid aortic valves
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Elastin‐Specific Autoimmunity in Smokers With Thoracic Aortic Aneurysm and Dissection is Independent of Chronic Obstructive Pulmonary Disease
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Editor's Choice – Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis
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Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection
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Comparison of Ascending Aortic Size in Patients With Severe Bicuspid Aortic Valve Stenosis Treated With Versus Without a Statin Drug
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Comparative Analysis of Hospital Costs of Open and Endovascular Thoracic Aortic Repair
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Variation in Maximum Diameter Measurements of Descending Thoracic Aortic Aneurysms Using Unformatted Planes versus Images Corrected to Aortic Centerline
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Measuring what matters to the patient: health related quality of life after aortic valve and thoracic aortic surgery
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Higher Mortality in Patients Undergoing Nighttime Surgical Procedures for Acute Type A Aortic Dissection
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Adherence to Prescribed Drugs Among 65–74 Year Old Men Diagnosed with Abdominal Aortic Aneurysm or Peripheral Arterial Disease in a Screening Trial: A VIVA Substudy
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Maternal and fetal outcomes in pregnancies complicated by the inherited aortopathy Loeys–Dietz syndrome
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A Frailty-Based Risk Score Predicts Morbidity and Mortality After Elective Endovascular Repair of Descending Thoracic Aortic Aneurysms
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Short- and long-term outcomes in isolated penetrating aortic ulcer disease
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PRKG 1 and genetic diagnosis of early‐onset thoracic aortic disease
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In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke
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Birth weight in pregnancies complicated by maternal heart disease
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African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms
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Current trends in the management of acute type A aortic intramural hematoma
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Cerebrovascular Disease Progression in Patients With ACTA2 Arg179 Pathogenic Variants
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Cost analysis of endovascular versus open repair in the treatment of thoracic aortic aneurysms
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Thoracic Mural Thrombi: A Case Series and Literature Review
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Growth rates of small abdominal aortic aneurysms assessed by computerised tomography – A systematic literature review
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Should the dilated ascending aorta be repaired at the time of bicuspid aortic valve replacement?†
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Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study
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Acute type B aortic intramural hematoma: the added prognostic value of a follow-up CT
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Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results
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Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection
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Protocol for a randomised controlled trial for Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS)
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Endovascular therapy for penetrating ulcers of the infrarenal aorta
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Surgical or Endovascular Therapy of Abdominal Penetrating Aortic Ulcers and Their Natural History: A Systematic Review
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Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm
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Impact of Hemodynamic Instability and Organ Malperfusion in Elderly Surgical Patients Treated for Acute Type A Aortic Dissection
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What Is the Specificity of the Aortic Dissection Detection Risk Score in a Low‐prevalence Population?
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Predictors of blunt abdominal aortic injury in trauma patients and mortality analysis
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Predictors of survival in malignant aortic tumors
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Male–female differences in quality of life and coping style in patients with Marfan syndrome and hereditary thoracic aortic diseases
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Regional biomechanical and failure properties of healthy human ascending aorta and root
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Thoracic endovascular stent-graft therapy in aortic dissection
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Hybrid repair of aortic aneurysm in patients with previous coarctation
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Aortic Disease in Patients with Marfan Syndrome: Aortic Volume Assessment for Surveillance
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Observation May Be Safe in Selected Cases of Blunt Traumatic Abdominal Aortic Injury
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A Meta-Analysis of the Association of Chronic Obstructive Pulmonary Disease with Abdominal Aortic Aneurysm Presence
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Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm
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Extent of Aortic Replacement in Type A Dissection: Current Answers for an Endless Debate
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Wall stress correlates with intimal entry tear localization in Type A aortic dissection†
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The fate of nonaortic arterial segments in Marfan patients
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Temperature Selection in Antegrade Cerebral Perfusion for Aortic Arch Surgery: A Meta-Analysis
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Incidence and characteristics of hospitalization for proximal aortic surgery for acute syndromes and for aneurysms in the USA from 2005 to 2014
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Health-related quality of life and lived experiences in males and females with thoracic aortic disease and their partners
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Does Immediate Operation for Symptomatic Non-ruptured Abdominal Aortic Aneurysm Compromise Outcome?
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‘No Touch’ Techniques for Porcelain Ascending Aorta: Comparison Between Cardiopulmonary Bypass with Femoral Artery Cannulation and Off-Pump Myocardial Revascularization
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Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease
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Developing a shared decision support framework for aortic root surgery in Marfan syndrome
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Non-contrast-enhanced magnetic resonance imaging for visualization and quantification of endovascular aortic prosthesis, their endoleaks and aneurysm sacs at 1.5 T
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Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection
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Time-to-operation does not predict outcome in acute type A aortic dissection complicated by neurologic injury at presentation
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Select type I and type III endoleaks at the completion of fenestrated endovascular aneurysm repair resolve spontaneously
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Long Term Outcomes of Endovascular Aortic Repair in Patients With Abdominal Aortic Aneurysm and Ectatic Common Iliac Arteries
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Long‐Term Imaging Evolution and Clinical Prognosis Among Patients With Acute Penetrating Aortic Ulcers: A Retrospective Observational Study
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Current management of the vascular subtype of Ehlers–Danlos syndrome
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Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up
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Age at detection of abdominal aortic aneurysms in siblings of patients with abdominal aortic aneurysms
Linné, A., Forsberg, J., Lindstrom, D. J., Ideskog, E., & Hultgren, R. (2016) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2015.10.057 · Cited by 21
Obstetric and cardiac outcomes in women with Marfan syndrome and an aortic root diameter ≤ 45mm
Minsart, A.-F., Mongeon, F., Laberge, A., Morin, F., Dore, A., & Leduc, L. (2018) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2018.09.012 · Cited by 21
Pregnancy after Aortic Root Replacement in Marfan's Syndrome: A Case Series and Review of the Literature
Williams, D., Lindley, K. J., Russo, M. L., Habashi, J. P., Dietz, H. C., & Braverman, A. C. (2018) · American Journal of Perinatology Reports · doi:10.1055/s-0038-1675347 · Cited by 21
Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms
Xuan, Y., D’Souza, S. N., Wang, Z., Suarez‐Pierre, A., Lawton, J. S., Ge, L. D., & Tseng, E. E. (2021) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2021.07.042 · Cited by 21
A Perspective on Natural History and Survival in Nonoperated Thoracic Aortic Aneurysm Patients
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Marfan syndrome, inherited aortopathies and exercise: What is the right answer?
Cheng, A. M., & Owens, D. S. (2015) · Heart · doi:10.1136/heartjnl-2014-306440 · Cited by 20
Screening for Familial Thoracic Aortic Aneurysms with Aortic Imaging Does Not Detect All Potential Carriers of the Disease
Hannuksela, M., Stattin, E., Johansson, B. H., & Carlberg, B. (2015) · Aorta · doi:10.12945/j.aorta.2015.14-052 · Cited by 20
In type A aortic dissection repair, an effective team approach and relational coordination are more important for patients' outcomes than surgeon volume
Preventza, O. A. (2017) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2017.02.034 · Cited by 20
A 26‐week feasibility study comparing the efficacy and safety of modified‐release prednisone with immediate‐release prednisolone in newly diagnosed cases of giant cell arteritis
Raine, C., Stapleton, P. P., Merinopoulos, D., Maw, W. W., Achilleos, K. M., Gayford, D., Mapplebeck, S., Mackerness, C., Schofield, P. N., & Dasgupta, B. (2017) · International Journal of Rheumatic Diseases · doi:10.1111/1756-185x.13149 · Cited by 20
Thoracic Endovascular Aortic Repair versus Best Medical Treatment for High-Risk Type B Intramural Hematoma: A Systematic Review of Clinical Studies
Li, L., Jiao, Y., Zou, J., Zhang, X., Yang, H., & Ma, H. (2018) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2018.03.010 · Cited by 20
Novel Approaches for BAV Aortopathy Prediction—Is There a Need for Cohort Studies and Biomarkers?
Girdauskas, E., Petersen, J., Neumann, N., Naito, S., Gross, T. M. S., Jagodzinski, A., Reichenspurner, H. C., & Zeller, T. (2018) · Biomolecules · doi:10.3390/biom8030058 · Cited by 20
Surveillance Recommendations after Thoracic Endovascular Aortic Repair Should Be Based on Initial Indication for Repair
Meena, R. A., Benarroch‐Gampel, J., Leshnower, B. G., Escobar, G. A., Duwayri, Y. M., Jordan, W. D., & Rajani, R. R. (2018) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2018.11.001 · Cited by 20
Optimal blood pressure control for patients after thoracic endovascular aortic repair of type B aortic dissection
Lu, N., Ma, X., Xu, T., He, Z., Xu, B., Qingfeng, X., & Tan, X. (2019) · BMC Cardiovascular Disorders · doi:10.1186/s12872-019-1107-2 · Cited by 20
Penetrating Atherosclerotic Ulcers of the Abdominal Aorta: A Case Report and Review of the Literature
Kotsis, T. E., Spyropoulos, B. G., Asaloumidis, N., Christoforou, P., Katseni, K. K., & Papaconstantinou, I. G. (2019) · Vascular Specialist International · doi:10.5758/vsi.2019.35.3.152 · Cited by 20

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2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association
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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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