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Should I get a second opinion about surgery?
Hi all, my name is Pattie. I was diagnosed Oct 2024 with giant cell arteritis which led to a CT scan. It was discovered that I have an ascending aortic aneurysm, 4.8cm to 5.3cm (depending on who's measuring). I just finished prednisone treatment for the GCA, supposedly it's in remission now. I was referred to cardiovascular thoracic surgeon for the aneurysm. She recommended open heart surgery to repair it with a graft. My valve is normal tricuspid. She's "calling" the aneurysm size 5.0, as she is "taking an average" between the measurements of 4.8-5.3 (obtained by 2 radiologists and an interventional cardiologist). Not clear if she actually measured it on imaging herself. She said my surgery should be "sooner rather than later" but that it's not "emergent", although she doesn't recommend a period of "watchful waiting". She's been pretty vague on the timing. Her rationale for surgery: She says 5.0 meets threshold for surgery, and that the "integrity of my vascular tissue may be compromised" due to GCA, and also family history... my father died at 63 from sudden cardiac death (unknown if caused by aneurysm, although he had hypertension and atherosclerosis). I also have hypertension (now controlled with BP meds).
I am 75 years old, 5'9" tall, very slim. I've read about aneurysm size (and also a person's height/body surface area) and such conflicting information about when it's appropriate to intervene surgically, including reports from people in this forum who have lived with their aneurysms that have been stable at larger sizes for years etc.
Getting very anxious about who to believe/trust. I am terrified at the thought of open heart surgery and the extensive recovery period. The hospital here is nice, the surgeon seems nice, but she said the hospital only does 10-12 aorta surgeries a year. I've done extensive research and reading. Wondering if I should seek out a second opinion from a reputable, high volume heart center. I'm in California... Stanford, UCSF, Cedars Sinai in LA all have second opinion services available online (you get a written report), but it's expensive of course. I suspect I'm probably going to get the same recommendation from other professionals, telling me to proceed with surgery. Does anyone want to weigh in on whether they think it's worth the hassle and expense for me to get a second opinion?
I'm just a bundle of nerves and so undecided about everything. Thanks in advance for any advice that's offered!
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You should get a second opinion from a center that handles these issues in volume. I think all those you have on your list do. A year ago I got a second opinion from Mayo Clinic in Jacksonville. They found 2 congenital issues and a genetic issue as well as an age related issue that the local cardiologist and hospital completely missed. I wouldn't have made it until this past Christmas.
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5 ReactionsYou want a surgeon who specializes in aortic aneurysms and who's done lots of surgeries. You should also look at the success rate of the hospital you entrust yourself to. Research is key. Knowledge is power.
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5 ReactionsOh wow. So glad you’re ok! Very good advice, thanks so much. I hadn’t even considered the fact that additional medical issues might also be uncovered when consulting for 2nd opinion. Appreciate your input!
Ah yes. Seek more experienced surgeon who’s done lots of these surgeries, I agree that’s critical. Don’t know how practical it will be for me to leave my area for the surgery though… but this is so important, practicality takes a back seat I guess. Thanks very much for your thoughts!
Hi Pattie. Suggestions from Pamela78 and rlhix are good ones. Its possible that you need further work up vs a second opinion. While this sounds like semantics, it also would mean a referral into an aortic specialist, which you do actually need. Your history of giant cell arteritis alone should require a deeper dive into further workup. In addition, your family history and body type indicates a need for genetic testing. These all factor into the prep and timing of potential surgery, and need to be discussed with an experienced aortic surgeon. As the others suggested, you should get a referral, vs a second opinion, into a high volume aortic center, especially with your co-morbidities. I know this is a very scary thing. Informed preparation improves outcomes. Good luck and best wishes going forward!
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5 ReactionsVery simple, always get a second opinion.
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2 ReactionsExcellent advice and insightful info, thanks! I would’ve never thought of all that. This is more complicated than I first realized. Appreciate your input!
You are so right. Thank you… keep it straightforward and simple!
Easier said than done but looks like, bottom line, seeking further professional input is a no brainer. Appreciate your help!
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1 ReactionI went 180 miles one way to get to Mayo Clinic. There was 1 surgeon in Tallahassee that is a bypass surgeon and he has done 1 aortic root surgery every 3 years or so. The higher volume the center, the higher the survivor rate.
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4 ReactionsJust curious... Since you got a second opinion at the Jacksonville Mayo Clinic, did you also get your surgery done there?
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