aortic disease

ACC/AHA Updates Aortic Disease Clinical Practice Guideline

Leigh Precopio

The American College of Cardiology (ACC) and American Heart Association (AHA) have updated their clinical practice guideline on aortic disease to now include recommendations on diagnosis and screening, genetic evaluation, medical therapy, endovascular and surgical treatment, and long-term management of patients with various clinical presentation subsets.1

This guideline, to be used in addition to the 2020 ACC/AHA guideline on valvular heart disease management, is intended to replace both the 2010 guideline on thoracic aortic disease and the 2015 guideline on surgery for aortic dilation in bicuspid aortic valves.

These recommendations are based on a literature review conducted from January 2021 to April 2021 and included additional studies published through June 2022 where appropriate.

The updated guideline makes several key recommendations, including noting that:

  • Shared decision making between the patient and a multidisciplinary medical team is essential to determine appropriate treatment, especially in individuals with aortic disease who are or may become pregnant due to increased cardiovascular risks during pregnancy, the diameter thresholds for prophylactic aortic surgery, and types of delivery.
  • The threshold for surgical intervention in individuals with sporadic aortic root and ascending aortic aneurysms is now 5.0 cm in select patients (previously 5.5 cm). This threshold may be lower in some patients with heritable thoracic aortic aneurysms.
  • For patients who are smaller or taller than average, clinicians may incorporate indexing of the aortic root or ascending aortic diameter to patient body surface area or height, or aortic cross-sectional area to patient height into surgical thresholds.

“There has been a host of new evidence-based research available for clinicians in the past decade when it comes to aortic disease. It was time to reevaluate and update the previous, existing guidelines,” concluded the writing committee chair Eric M. Isselbacher, MD, MSc, in a press release.2 “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.”



  1. Isselbacher EM, Preventza O, Black JH, et al; American College of Cardiology and American Heart Association Writing Committee. 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. Circulation. 2022;146:e334-e482. doi:10.1161/CIR.0000000000001106
  2. ACC, AHA issue aortic disease guideline. News release. American College of Cardiology; November 2, 2022. Accessed December 27, 2022.