Early surgery: Getting aortic aneurysm repair before it's 5.0

Posted by ontogenyx @ontogenyx, Sep 26 9:22am

I have a 4.1 ascending aortic aneurysm, and my local cardiologist tells me what every other one tells me, including Cleveland Clinic and Mayo. No surgery considered until 5.0, if valves are in good shape (mine are, except for 5% regurgitation).

The rationale offered for waiting: the risk of the surgery is greater than the risk of an event resulting from the aneurysm before it reaches 5.0. Meanwhile, I am told to limit myself to moderate exercise and to take drugs, in hopes of slowing growth of aneurysm.

I will be 71 next month, in good health, and very active. I am more interested in getting the repair done now so that I can resume a full life, rather than waiting around until I get feeble and less likely to have a good result when they eventually open me up for repair. I am much more willing to accept the risk of the surgery now than I will be 10 years down the road. I know, I know–it might never even require surgery–in which case, I can continue my life of “moderate exercise” until my number is finally up. Not interested.

Does anyone know a top surgeon who is willing to talk with me about getting this done now or in the near future? Thank you.

Hi @ontogenyx, great question. I augmented the title of the discussion to reflect the question you'd like to ask regarding waiting for surgery until ascending aortic aneurysm is 5.0 and meanwhile having to limit an active lifestyle and control with drugs. Fellow members like @maryswims @ginko @twojunes2 @cobweb @degarden_girl @crhp194 @morninglory @dinis @sleepykat @azzurro1999 @pete398 and others have considered similar questions, and can provide doctor recommendations and their thoughts about decision making.

You might also be interested in reading their posts in this discussion:
* Ascending aortic aneurysm – repair/surgery https://connect.mayoclinic.org/discussion/ascending-aortic-aneurysm-repairaortic-valve-replacement-after-70

You mention that you're in good health and active. What types of activities do you wish to be able to continue and may have to tone down due to the aneurysm?

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Cutting and splitting firewood. Singles tennis.

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Believe me, do not get the surgery, .you are fine. The surgery is as invasive as open heart surgery. My Aorta is 5.1 cm and my cardiologist will not be concerned until 5.5csm. However, I do have a ct scan check every year to monitor any changes, So far no changes. Furthermore, No one has any idea if this has been the size of my Aorta for years. I would take the yearly monitoring route and ease your worry.

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I am not at all sure that Medicare will pay for surgery before it is at least a 5.0. You might check that before you go further. When I had the surgery, mine was nearly 6. I had no symptoms and it was discovered accidentally. While my surgery was very successful, it was not without risk. The surgery is lengthy and the recovery time is not so easy. Have doctors told you you cannot play tennis. Up until my surgery, I did play pickle-ball unaware of my aneurysm and suffered no ill effects. In any case, the best to you and good luck.

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@ontogenyx

Cutting and splitting firewood. Singles tennis.

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@ontogenyx, Although I recommend checking with your cardio, I don't see singles tennis being a problem. The wood cutting and chopping might be a concern because of the weight of the saw and the maul.

I understand your impatience to just get this done, get back to "normal. But I think with your aneurysm so small, any cardio surgeon worth their salt would say NO in no uncertain terms. Cardiac surgery is serious stuff and things can go wrong — and that is why responsible surgeons will not take a chance when the surgery is not yet necessary. If you find a surgeon who is willing to do this surgery, run the other way.

I wish you peace and continued good health.
Donna

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What State are you in? Willing to travel to Northern California?

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No travel restrictions inside U.S.

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I knew about my aneurysm more than ten years ago, when it was still small. (Around 3.something cm) It was found when a neurology nurse working with me on chronic migraines noticed that my blood pressure was spiking. My primary doctor wasn't terribly worried, even with my father having passed at a young age with an abdominal aortic aneurysm rupture. She did an EKG and, as a result, sent me to a cardiologist. That cardiologist put me on BP medication and said not to worry, that we would keep an eye on it with echos. A few years ago, he sent me to a surgeon because it had grown. That surgeon told me not to worry, that it might never need surgery. Last month, that same surgeon told me that it was now at 5.0 cm and that its rate of growth calls for surgery ASAP. I have made an appointment at Mayo for a second opinion (a month and a half out) but may opt to have the surgery earlier with the original surgeon at Regions in St.Paul because I am concerned about waiting. My advice, you may never need surgery but don't count on that. The rate of growth could and probably will change. Make sure you are prompt about testing. Take it seriously. And note that words like "may" and "could" are not the same as "will" and "is."

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