39yr male with aortic 47... No gym? :(

At 39 with an ascending aorta at 47 mm, you are in a gray zone. Many centers consider surgery once it reaches 50–55 mm, unless there are risk factors (family history of dissection, rapid growth, connective tissue disorder, bicuspid valve, uncontrolled blood pressure). Your growth from 42 mm to 47 mm over 7 years shows progression but not explosive growth. That’s good, but it means you need careful surveillance.

On fitness: light activity is encouraged. Walking, light cycling, stretching, yoga without deep twists, bodyweight work — these are usually safe. What you must avoid are heavy weights, straining, breath-holding (Valsalva), and anything that spikes blood pressure suddenly. Every surgeon I’ve talked to has said: “move, but don’t strain.” I still exercise daily, but it’s controlled and intentional.

On surgery: you’re right, the permanent solution is open surgery with a graft. Stents are not a forever fix for the ascending aorta. Surgery at 47 mm may be early unless you have added risk factors. Some surgeons will consider earlier intervention if there’s rapid enlargement or if the patient has a connective tissue disorder. You should absolutely be followed at a high-volume aortic center and get a surgeon’s opinion — not just a cardiologist.

After surgery: you are not “bulletproof.” The graft is strong, but the rest of your aorta still ages. You’ll need lifelong surveillance. But you can usually return to a fuller, safer life with more confidence. Many of us exercise moderately after graft repair.

What I’d do in your shoes:
– Get under the care of an aortic specialist surgeon, not just a general cardiologist.
– Nail down strict blood pressure control. Meds are often lifelong; don’t see them as failure.
– Clean up diet: less salt, fewer energy drinks (those spike BP), more consistent healthy food.
– Exercise lightly but regularly, with no straining.
– Stay on regular imaging — every 6–12 months as advised.

I hear the fear and frustration in what you wrote. I went through my own Type A dissection at 50 years old — emergency open-heart surgery, Dacron graft, and the whole life-changing aftermath. So I speak as someone who lived this, not as a doctor, but as a survivor who has learned from world-class thoracic surgeons along the way. You are not alone in this. Knowing about it is your gift. I didn’t have that chance — mine ripped open before I ever knew it was there. You still have time to act wisely and stay alive. Peace.

@moonboy your response ‘ After surgery: you are not “bulletproof.” The graft is strong, but the rest of your aorta still ages‘ - aging aorta applies to everyone or because of the graft the other areas of aorta are not that strong

I had my surgery in 2020. at 5.2 cm and 54, I workout regularly and with reasonable intensity. My cardiologist has told me that there are cases were the aorta dilates where it meets the graft, or if you have propensity to get aneurysms you may get another one in your lifetime (it may not grow to need surgery but it could). So it is paramount to watch BP even after surgery, so I believe Moonboy refers to the fact that nothing will happen at the graft, but the rest of your aorta is still vulnerable and it will age with you.

My cardiologist orders full MRIs (groin, abdomen, chest and head - I also had a brain aneurysm that was repaired) every 4-5 years to ensure no new aneurysms are appearing, and sees me every year after an echo to check the graft and my aortic valve (mine is bicuspid and will need replacement at some point).

A few months after surgery I started working out again, increasing the intensity slowly, 5 years later I do full workouts and strength training with weights but nothing excessive. I have also learned how to properly breathe so that I don't hold my breath even by accident, even if the weights are reasonable, nothing that i struggle too much to lift.

But before surgery you need to follow Moonboy's recommendations, nothing that leads you to hold your breath while exerting, BP rises significantly during those moments and even those short bursts of high BP are very detrimental to your aneurysm. On the other hand keeping your body healthy is very important in case you need surgery, the healthier your body the higher your probability of having no issues and will ensure a quick recovery.

Besides a specialist surgeon (someone who has done this type of procedures hundreds/thousands of times), I recommend you find a cardiologist who specializes in aortic diseases, not all of them do and it makes a huge difference. The surgeon will see you before and during surgery, and maybe a couple of times after, the cardiologist will see you for the rest of your life, getting the right one will ensure you have the right follow up.

All the best to you!!!