The EACTS/STS aortic organ guidelines, and one ACC/AHA statement on tactical athletes

No new guidelines in primary scope today. Thirteen journals swept for 2–4 September. Two hits: an EHJ “Weekly Journal Scan,” which is a commentary rather than guidance, and one genuine scientific statement noted at the end of this entry.

The main work today went to the standing landmark list — and closed its largest cardiothoracic gap.

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

Society · Published: European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons. EJCTS, 26 February 2024 (DOI 10.1093/ejcts/ezad426), published in parallel in the Annals of Thoracic Surgery (DOI 10.1016/j.athoracsur.2024.01.021). ~2.5 years old, never covered here. Czerny and Grabenwöger (co-chairs), Berger (task force coordinator), with an international task force. Corrigenda exist from June 2024 and July 2026 — worth checking before quoting a specific figure.

Access note: no abstract is deposited in Europe PMC. What follows was retrieved from the publisher’s visible article page — abstract and opening sections. This is not a reading of the full guideline, which runs to a substantial document; treat the below as an orientation to its main ideas, not a summary of its recommendations.

The “aortic organ” concept

The framing change the title announces: rather than treating the aorta as a large vessel that distributes blood, the guidelines treat it as “a functional unity” with its own vital functions — recognising its embryologic origins, heterogeneous tissue composition, and interconnected segments, and arguing for integrated diagnostic and therapeutic strategies across those segments.

Four substantive changes

1. TEM classification — Type / Entry / Malperfusion. More granular than Stanford or DeBakey, and specifically able to describe “non-A non-B” dissections involving the arch, which the older systems handle badly.
2. Ishimaru zones (0–11) adopted as standardised nomenclature, so that the extent of aortic disease is reported consistently across specialties.
3. The GERAADA score for predicting 30-day mortality in acute type A dissection.
4. Bicuspid aortic valve aortopathy phenotyping into root, ascending and extended phenotypes.

Diameter thresholds, as visible

• Aneurysm of the aortic root and ascending aorta: >45 mm
• Dilation of root and ascending aorta: 40–45 mm
• Descending and abdominal aorta: aneurysm defined as 1.5-fold normal vessel diameter
• Normal aortic values may need ethnic-specific adjustment

Interpretation. Three of the four changes are about language rather than therapy, and that is the point. TEM and the Ishimaru zones exist because Stanford and DeBakey cannot describe an arch dissection precisely enough for a surgeon, an interventionalist and a radiologist to be confident they mean the same thing — and “non-A non-B” was the gap that made this obvious. Classification changes of this kind are unglamorous and have more effect on real practice than most recommendation upgrades, because they change what gets written in the report the next clinician acts on.

The GERAADA score is the most immediately usable item for anaesthetic and intensive care practice: a validated 30-day mortality estimate in acute type A dissection is exactly what is missing in the middle of the night when the conversation is about whether and how aggressively to proceed.

It also connects to work sent last week. The JTCVS analysis of prior cardiac surgery in type A dissection found redo status was not independently associated with major adverse events once comorbidity was accounted for — a finding that is much easier to act on when there is a scoring system to quantify the comorbidity, which is what GERAADA provides.

Still outstanding: the full text. If your institution has EJCTS or Annals access, the complete recommendation tables and the BAV phenotype definitions are the parts worth having, and I would write those up properly from a PDF.

EJCTS · Annals of Thoracic Surgery

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Also found: ACC/AHA statement on the tactical athlete

ACC/AHA Scientific Statement, JACC, 3 September 2026 — genuinely new, but tangential to your scope, so noted rather than covered.

Guidance for clinicians caring for firefighters, law enforcement officers and military personnel with cardiovascular disease or risk. Eleven sections, each with “Clinical Considerations Tables,” shaped by the interaction between occupational demands and fit-for-full-duty assessment — including how a cardiovascular event in such a person affects teammates’ safety, community safety and mission success.

Recorded here because it is a genuine society statement found in the sweep. If occupational fitness assessment is part of your practice it may be worth a look; otherwise it sits outside anaesthesiology, intensive care and cardiothoracic surgery.

Read the statement