In a 2022 guideline issued by the ACC and AHA and published 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, MD, and colleagues conducted a comprehensive literature search to develop recommendations on diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease. They 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 select 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.
