2
Overview
Top 10 Take-Home Messages for the Diagnosis and
Management of Aortic Disease
1. Because outcomes for patients with aortic disease are enhanced
at programs with higher volumes, experienced practitioners,
and extensive management capabilities, Multidisciplinary Aortic
Team care is considered in determining the appropriate timing of
intervention.
2. Shared decision-making involving the patient and a multidisciplinary
team is highly encouraged to determine the optimal medical,
endovascular, and open surgical therapies. In patients with aortic
disease who are contemplating pregnancy or who are pregnant,
shared decision-making is especially important when considering
the cardiovascular risks of pregnancy, the diameter thresholds for
prophylactic aortic surgery, and the mode of delivery.
3. Computed tomography, magnetic resonance imaging, and
echocardiographic imaging of patients with aortic disease
should follow recommended approaches for image acquisition,
measurement and reporting of relevant aortic dimensions, and the
frequency of surveillance before and after intervention.
4. 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 cm
to 5.0 cm in selected patients, and even lower in specific scenarios
among patients with heritable thoracic aortic aneurysms.
5. In patients who are significantly smaller or taller than average,
surgical thresholds may incorporate indexing of the aortic root or
ascending aortic diameter to either patient body surface area or
height, or aortic cross-sectional area to patient height.
6. Rapid aortic root growth or ascending aortic aneurysm growth,
an indication for intervention, is defined as ≥0.5 cm in 1 year or
≥0.3 cm per year in 2 consecutive years for those with sporadic
aneurysms and ≥0.3 cm in 1 year for those with heritable thoracic
aortic disease or bicuspid aortic valve.
7. In patients undergoing aortic root replacement surgery, valve-
sparing aortic root replacement is reasonable if the valve is suitable
for repair and when performed by experienced surgeons in a
Multidisciplinary Aortic Team.
