I would say, given your situation, assuming that you’re somewhere in a beautiful remote Pacific Island, that you probably should consider the prospects of meeting with the thoracic surgeon in a major Medical Center near you. This is not the kind of condition that lens itself well to emergencies. I dissected in 2015 I was in the middle of San Diego and was in an ambulance within three minutes. I barely survived. If access to medical care is hours away the likelihood that you would survive a sudden dissection is pretty small I would think. So given that, I think you owe it to yourself and your family to meet with a thoracic surgeon who specializes in aortic repair. I don’t say that lately I sat with direct experience. If you live out in the middle of nowhere and emergency, open-heart surgery is hours away by boat or helicopter, you’ve got a real problem I would think. So the solution is to meet with the thoracic surgeon who does the surgeries and explain to them your geographic situation and ask them whether or not that risk could be mitigated by earlier surgery. I’m not a doctor, but I am a survivor of a massive aortic dissection and I can tell you that having been in downtown San Diego made a massive difference in my survival chances. If I knew then what I know now, I would’ve opted for surgery 1000 times out of 1000 rather than wait for a dissection. And one more important point: my experience has been that cardiologist who prescribe pills and even do interventional cardiology with stance do not have any Real concept of what a dissection feels like or how to surgically survive it. You need to meet with a thoracic surgeon who’s an aortic specialist. They’re out there. Especially in a Pacific Paradise! Peace.