EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ

These guidelines on aortic disease are very welcome and awaited by all of us who manage patients, whether in acute or chronic settings. To begin with and in a novel way, it coins new terms such as chronic aortic syndrome and “the aortic organ” itself, which give greater prominence and uniqueness to aortic pathology. On the other hand, it is a prime example of a multidisciplinary document – as is the own pathology referred to.
At the outset, it begins with a highly illustrative initial figure that clearly and visually explains aortic pathologies according to its different segments. Also new is the table in which reference is made both to the nomenclature - with the Ishimaru zones - and the new TEM terminology for classification - as well as to risk stratification including the GERAADA score risk calculator.

Also very relevant is the importance of the multidisciplinary aortic team –as well as the aortic centers- special emphasis is also placed on the need for teaching and training. Importantly, the document emphasizes that the patients need to be involved in the shared-decision making process
In another order of things, the diagram on Bicuspid aortic valve aortopathy (BAVA) and its different phenotypes is very appreciated.

The section on imaging techniques is, as it could not be otherwise, broad and clearly explains the usefulness of each technique and the methodology to be used when reporting the reports.
Entering into the management of acute aortic syndrome, a novel scheme is included under the heading of “conceptual approach” in which the attitude in each of the different scenarios of acute aortic dissection type A is reflected. Similarly, separate schemes are included that refer to both non-A, non-B and type B dissection. Intramural hematoma and penetrating ulcer have their specific and broad sections including high-risk criteria in both entities.

After acute aortic syndrome, chronic aortic pathology is addressed and this is where there are several new developments that also seem notable to us: In patients with low surgical risk and 'ascending phenotype' dilation, both with TAV and BAV, surgical treatment should be considered when the maximum aortic diameter is >52 mm. Therefore, a new 52mm threshold is included and on the other hand, this section is included: 
In patients with low surgical risk and ‘ascending phenotype’ BAV-related aortopathy, surgery should be considered at a maximum diameter> 50mm if any of the following is present:
• age <50 years
• short stature (<1.69 m)
• ascending aortic length >11 cm
• aortic diameter growth rate >3 mm/year
• family history of the acute aortic syndrome
• aortic coarctation
• refractory hypertension
• shared decision with the patient
• concomitant non-aortic valve cardiac surgery

With clear changes with respect to the previous guidelines by including short stature, the length of the affected aorta, among others. 
A section on chronic dissection and thresholds for intervention is included, and the section on hereditary aortopathies also deserves special mention, in which specific recommendations are made for certain pathogenic variants.
The therapeutic options section is extensive, very specific and with fabulous iconography. A special section is made on aortic pathology in women and finally general recommendations for patients with aortic pathology. In short, guides of enormous interest and fascinating reading.