BREAKING Medical News! International Medical Community Now Recognizes The Aorta As An Independent Organ!

Medical News: In a groundbreaking development, the international medical community has officially recognized the aorta, commonly known as the main artery, as an independent human organ. The European Association for Cardiothoracic Surgery (EACTS) and the US Society of Thoracic Surgeons (STS) jointly established guidelines that categorize the aorta as an organ. This monumental decision, outlined in the European Journal of Cardio-Thoracic Surgery and The Annals of Thoracic Surgery on February 26, 2024, has far-reaching implications, reshaping medical specialties and enhancing patient care.


Medical Community Now Recognizes The Aorta As An Independent Organ

The Aorta's Elevated Status
The aorta's new classification positions it alongside vital organs such as the heart, lungs, and brain. Professor Dr Martin Czerny, Medical Director of the Department of Cardiovascular Surgery at the University Heart Center of the Medical Center - University of Freiburg, emphasizes the significance of this recognition. Previously, aortic diseases were treated in either cardiac or vascular surgery based on type and location. The guidelines now advocate for a dedicated specialty focused on the aorta, promoting an integrative approach.
 
Holistic Perspective and International Recognition
Professor Czerny, a globally recognized figure in cardiovascular surgery, led a team of experts in developing the guidelines, emphasizing the integrative approach practiced at the Medical Center - University of Freiburg. Professor Dr Frederik Wenz, CEO of the Medical Center, acknowledges the center's outstanding position in cardiovascular medicine. The guidelines are expected to influence medical studies, specialist training, and further enhance the treatment of patients with aortic diseases.
 
Professor Czerny told Medical News journalists, "Recognizing the aorta as an organ puts it on a par with the heart, lungs or brain. This is a big step. Until now, aortic diseases have usually been treated either in cardiac surgery or in vascular surgery, depending on their type and location. The new guidelines clearly recommend bundling the treatment of the aorta in a separate specialty, naturally in close coordination with other specialties. We have been practicing this integrative approach at the Medical Center - University of Freiburg for a long time and I am delighted that our work is now also being recognized internationally. I am certain that this will improve the treatment of patients with aortic rupture and other serious diseases. The guidelines could also have an influence on the content of medical studies and specialist training.”
 
The Aorta's Complex Functions
The aorta, responsible for transporting oxygen-rich blood from the heart to the body, has now been acknowledged for its additional roles. Beyond its primary function, the aorta plays a crucial role in regulating blood pressure, blood flow velocity, and hormone production. With its own layer of smooth muscle cells, the aorta maintains its structural integrity and function.
 
Guidelines for Diagnosing and Treating Aortic Diseases
The newly established guidelines provide a comprehensive framework for diagnosing and treating aortic diseases, particularly aortic aneurysms. Aortic aneurysms, abnormal bulges in the aortic wall, pose a high risk of life-threatening ruptures, necessitating emergency surgery. The guidelines stress the importance of a holistic understanding of the aorta for improved comprehension, research, and performance of complex surgical interventions.
 
Transformative Shift in Perception
The recognition of the aorta as an independent organ marks a transformative shift in medical perception. Originating from Raimund Erbel's groundbreaking work on the 'vessel aorta' in 2001, this shift has led to a series of guidelines and expert consensus documents. The document acknowledges the unique function of the aortic organ, prompting a reevaluation of its physiology and pathophysiology.
 
Development of the Aorta and Aortic Disease Mechanisms
The guidelines delve into the developmental origins of the aorta, emphasizing its heterogeneous nature. From the secondary heart field, neural crest, and mesoderm, the aorta's embryologic journey shapes its tissue texture and structure. Smooth muscle cells, key players in aortic tissue, interact with the extracellular matrix, maintaining aortic homeostasis. Changes in smooth muscle cells contribute to the development of aortic diseases.
 
Fibrillin-1, a crucial component of the extracellular matrix, plays a vital role in transducing mechanical stress. The guidelines highlight the impact of aging on aortic distensibility, involving changes in glycosaminoglycans, extracellular collagens, and elastin content. Variants in genes associated with the transforming growth factor-β (TGFβ) signaling pathway contribute to aneurysm formation.
 
Epidemiology of Aortic Diseases
The guidelines shed light on the epidemiology of thoracic aortic aneurysms (TAAs) and acute aortic syndromes (AASs). The incidence of TAAs has increased, with variations reported across different studies and regions. Aortic dissection prevalence ranges from 0.2% to 0.8%, emphasizing the challenges in accurate diagnosis and the need for timely interventions.
 
The latest guidelines also describe the procedure for diagnosing and treating diseases of the aorta such as aortic aneurysm. An aneurysm is an abnormal bulge in the aortic wall that harbors a high risk of an acutely life-threatening rupture. If the aorta ruptures, emergency surgery is required.
 
Professor Czerny added, "These diseases require complex surgical interventions, which we can better understand, research and perform thanks to the holistic view of the aorta. Very good follow-up care is also very important, as those affected often show dangerous changes in the aorta again later in life.”
 
Data on abdominal aortic aneurysms (AAAs) indicate a decreasing prevalence, attributed to improved cardiovascular risk management and reduced smoking rates. National screening programs contribute to identifying AAAs, enabling early intervention and reducing hospitalization and mortality rates.
 
The Future of Aortic Medicine
The guidelines signal a continuous evolution in understanding the aortic organ's pathophysiology, treatment timing, and therapeutic strategies. Aortic disease has emerged as a specialty with significant health economic relevance. The guidelines set the foundation for specialized centers, emphasizing interdisciplinary collaboration in treating the aortic organ. In the ever-advancing field of aortic medicine, the guidelines serve as a valuable platform, guiding physicians in providing informed, collaborative, and effective care to patients with aortic diseases.
 
The new medical guidelines on the classification of the aorta as an independent organ are found here:
https://academic.oup.com/ejcts/article/65/2/ezad426/7614462
 
https://www.annalsthoracicsurgery.org/article/S0003-4975(24)00077-8/abstract
 
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