2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease

. Author manuscript; available in PMC: 2023 Dec 13.

Published in final edited form as: J Am Coll Cardiol. 2022 Nov 2;80(24):e223–e393. doi: 10.1016/j.jacc.2022.08.004

Recommendations for Surgery for Sporadic Aneurysms of the Aortic Root and Ascending Aorta

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	RECOMMENDATIONS

1	C-LD	1. In patients with aneurysms of the aortic root and ascending aorta who have symptoms attributable to the aneurysm, surgery is indicated.^1,2

1	B-NR	2. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.5 cm, surgery is indicated.^3–9

1	C-LD	3. In patients with an aneurysm of the aortic root or ascending aorta of <5.5 cm, whose growth rate confirmed by tomographic imaging is ≥0.3 cm/y in 2 consecutive years, or ≥0.5 cm in 1 year, surgery is indicated.^10–13

2a	B-NR	4. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have a maximum diameter of ≥5.0 cm, surgery is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.^14–17

2a	B-NR	5. In patients undergoing repair or replacement of a tricuspid aortic valve who have a concomitant aneurysm of the ascending aorta with a maximum diameter of ≥4.5 cm, ascending aortic replacement is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.^18–21
2a	B-NR	In patients undergoing repair or replacement of a tricuspid aortic valve who have a concomitant aneurysm of the ascending aorta with a maximum diameter of ≥5.0 cm, ascending aortic replacement is reasonable.^18–21
2b	C-LD	In patients undergoing cardiac surgery for indications other than aortic valve repair or replacement who have a concomitant aneurysm of ascending aorta with a maximum diameter of ≥5.0 cm, ascending aortic replacement may be reasonable.¹⁸

2a	C-LD	6. In patients with a height >1 standard deviation above or below the mean who have an asymptomatic aneurysm of the aortic root or ascending aorta and a maximal cross-sectional aortic area/height ratio of ≥10 cm²/m, surgery is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.^14,15,22

2b	C-LD	7. In asymptomatic patients with aneurysms of the aortic root or ascending aorta who have either an ASI of ≥3.08 cm/m² or AHI of ≥3.21 cm/m, surgery may be reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.²³