Hey Matt, welcome. I survived an ascending aortic arch dissection in 2015. You’re lucky you know you have a problem. I did not. you do not want to wait to find a surgeon. I had mine done at UCSD La Jolla on an emergency basis. Less than 45 minutes between the onset of pain and open-heart surgery. To say it was a surprise would be the understatement of a lifetime. I would get a referral to a good thoracic surgeon that is in major top 50 Surgical Center. My opinion is that you want to schedule surgery maybe on a Monday morning when the surgeon is fresh hopefully off of a relaxing weekend. There was just a study done saying that surgical outcomes are a lot better on certain days of the week. Google it because I frankly can’t remember exactly what it said, but there are definitely better days than others to schedule this kind of major surgery. Once you find a good thoracic surgeon who can look at your scans, they can give you advice on when you will probably want to seriously consider having the surgery. My understanding is that when it’s done on a scheduled planned basis, the outcomes are always a lot better than how I had it which was as an absolute 100% five alarm emergency. It was no fun. No doubt this is gonna be a challenge for you but here I am 10 years later. On my way to San Diego again from Minneapolis tomorrow morning. I live here and I had my dissection during a business trip to California in 2015. I love San Diego, but I have lots of mixed feelings about how much my life changed in an instant there 10 years ago. In any event, start looking for sure now once you get to 5 cm you’re going to be a candidate for Surgery. Keep your blood pressure down. Tell you no grunting when you’re lifting, and get good advice from that thoracic surgeon. Cardiologist do not do thoracic surgery surgery. They have some insight, but nothing like a good fashion surgeon. Who’s gonna do the work. Peace.