New Guidelines For Aortic Disease Diagnosis and Management

 The American College of Cardiology and American Heart Association joint committee on clinical practices issued new guidelines for the diagnosis and management of aortic disease, published in the Journal of the American College of Cardiology (JACC).

The recommendations provide guidance for clinicians on diagnostic, surgical considerations and surveillance for syndromic, non-syndromic heritable thoracic aortic diseases and other congenital and medical causes of aortic disease. The scope of the guidelines includes both abdominal and thoracic aorta, addressing genetic evaluation, family screening, imaging measurement approaches and reporting for diagnostic and long-term surveillance of patients with aortic disease.

The new guidelines encourage comprehensive care for patients with multidisciplinary aortic team of experts and emphasizes on shared decision-making, to determine timing of intervention and optimal medical, endovascular and surgical therapies. Shared decision-making is especially important before and during pregnancy when considering the cardiovascular risks of pregnancy, the diameter thresholds for prophylactic aortic surgery, and the mode of delivery.

Surgical thresholds may be adjusted based on patient genetics, rapid aortic growth rate, indexing aortic size or aortic height or cross-sectional aortic area to patient height. At centers with Multidisciplinary Aortic Teams and experienced surgeons, the threshold for surgical intervention for sporadic aortic root and ascending aortic aneurysms has been lowered from 5.5 to 5.0 cm in selected patients, and even lower in specific scenarios among patients with heritable thoracic aortic aneurysms. In the future, gene-based precision medicine and patient-centered approaches will enable care plans to optimize outcomes for each patient.

Click Here for the full guidelines

For more information and useful clinician and patient tools related to the Guideline, visit ACC's Aortic Disease Guideline Hub

These guidelines were written by a team of selected multidisciplinary aortic specialists and are based on comprehensive literature searches and expert opinions on data from observational studies, large registries and prospective studies. Two executive members from the Montalcino Aortic Consortium (MAC), Dr. Dianna Milewicz, Medical Geneticists, UTHealth in Houston and Dr. Alan Braverman, Cardiologist, Washington University School of Medicine in St. Louis were part of the guidelines writing committee. GADA acknowledges Dr. Milewicz and Dr. Braverman for their expertise and insights for gene-based precision medicine from the MAC research findings, on the guidelines committee. GADA, a co-founder of MAC, is proud to fund the registries for MAC research.

We are honored to host a webinar on Wednesday November 23, 2022 @ 2 pm ET, with Dr. Dianna Milewicz, MAC Executive Chair and Dr. Jennifer Chung, Cardiovascular Surgeon, PMCC, Toronto, to talk about the new guidelines and how they affect clinical practices for those with genetic aortic disease. It will be a great opportunity to learn about the guidelines and ask questions.

Please register for the webinar. The event is free, but registration is required to attend.

About the speakers:

Dr. Dianna M. Milewicz MD, PhD
Division Director, Professor, Vice-Chair, Medical Genetics. The University of Texas Health Science Center at Houston
Executive Chair, MAC Aorta - Montalcino Aortic Consortium

Dr. Milewicz, is the President George H.W. Bush Chair of Cardiovascular Medicine, Director of the Division of Medical Genetics and Vice-Chair of the Department of Internal Medicine at the University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School. She completed her postgraduate training in internal medicine, specialized further in medical genetics, and forged a career in translational studies focused on genetic predisposition to vascular diseases. She has received numerous honors and awards for her research, including the Antoine Marfan Award, the Doris Duke Distinguished Clinical Scientist Award and the University of Texas Presidential Scholars Award for Excellence in Research. She has been inducted into the American Society of Clinical Investigation and the Association of American Physicians. Dr. Milewicz is the Past Chair of GADA Professional Advisory Board and continues to provide her expertise as an active member of the PAB. Dr. Milewicz is the Executive Chair of the Montalcino Aortic Consortium (MAC), managing the largest genetic Aortopathy research registry in the world.

Dr. Jennifer Chung MD, MSc, FRCSC
Cardiovascular Surgeon, Director Thoracic Aortic Surgery Clinic
Peter Munk Cardiac Center, Toronto General Hospital
Co-Program Director for the Advanced Aortic Surgery Fellowship

Dr. Chung is a Cardiovascular Surgeon with the Cardiac Surgery team at Toronto General Hospital. She studied Engineering Science at University of Toronto and Medicine at Queen’s University and completed residency in Cardiac Surgery at McGill University, during which she completed a Master’s of Science studying Aortic Biomechanics. She completed a fellowship in Advanced Aortic Surgery at the University of Toronto. The scope of her practice includes general cardiac surgery with a subspecialty in aortic surgery. She focusses on both open and endovascular repair of aneurysms of the aortic root, arch and thoracoabdominal aorta.