Two opposing recommendations on surgery

I am 60 and I survived an ascending aortic dissection 10 years ago. It was a nightmare and I barely survived. I would not recommend it for anyone. The chance of surviving a sudden dissection are slim if you are not lucky enough to be close to a major surgical center with the right aortic expert thoracic surgeon ready to go. I would not chance it knowing what I know now. I did not know that I had a problem until I had a problem.

You have the benefit of knowing that you have an aneurysm, which is at surgical levels now that it's at 5 cm. If it were me, I would have that surgery tomorrow. A planned surgery has much better outcomes than an emergent surgery like mine. I know that it's a daunting decision to make, but you need to listen to your surgical team and make the decision.

Think of it this way: it's sort of like having a huge bulge in the side of your tire and then deciding you're just going to continue to drive on it until something happens and hope for the best, as opposed to proactively getting the tire repaired while you're in town, near a shop that can handle it, and that has all the parts available to deal with it.

No one can make the decision for you, but I will tell you that I most certainly would have undergone planned surgery long before I would have waited for an emergency surgery when I was 1600 miles from home and in a hotel room on business in the middle of the night in San Diego. Peace.

Hight and size of aneurysm/growth of aneurysm (https://www.jtcvs.org/article/S0022-5223(17)32769-1/fulltext) seems to be the gold standard for risk determination these days. It might be worth looking at it. I know being taller my risk of dissection is technically lower with a tricuspid valve and if I have slow growth. The older way of judging to wait or do surgery was body size which does not to be as accurate. So it probably depends on which scale the doctor is using for recommendation

Given the rate of growth and size, I tend to think the 2nd surgeon is correct. The key is to have an experienced surgeon, team and center.

I got 2 opposite opinions from surgeons under the same university hospital affiliation. First one said ohs was only option. Second one said no surgery needed, only cath and keep an eye on valves. Second one said tavr would be an option.
Obviously, a third opinion is in order.

Where is the aneurysm? Is it ascending aorta and or root? Descending Aorta or abdominal aorta? TAVR isn't likely on the root and or ascending aorta.

Thank you. I needed to hear that.

Generally the standard for an ascending aortic aneurysm is either: 5.5 cms OR a growth rate of .5 cms in one year, according to the latest standards. I watched my ascending aneurysm get to 5.3 (with echos every 6 months) and I also have a BAV that needed repair. I had the surgery recently and although it IS a difficult surgery (and recovery- for me anyway) I agree that surviving an emergency surgery as a plan- is a really a BAD IDEA. My Aorta was replaced and the BV was repaired and still in the ICU 9 days. I was 68 when this was done. It seems to be inevitable and your body can recover from being on the pump for an extended period when you are younger- something you really need to consider.

Good luck and I would agree with your second doctor.