Early surgery: Can I get aortic aneurysm repair before it's 5.0?

Hi, I discovered I have an ascending aortic aneurysm 12 months ago while screening for cancer because I've been diagnosed with a low white blood cell count several years ago. It was measured at 5.0 cm and 6 months later at 5.1. I was put on Lipitor and Zebeta. I turned 65 in May and went on Medicare. My new cardiologist measured 4.7 cm in an echocardiogram in December and confirmed it again in a CT scan this month (Jan.). When I visited my new heart surgeon this week, he insisted on surgery. He showed me a "2022 ACC/AHA Guideline for Diagnosis and Management of Aortic Disease" report where the threshold for intervention has been lowered from 5.5 cm to 5.0 cm. He also referred to a metric where risk can be calculated based on the diameter and body height. When I responded that I've been told that 5.5 cm was the threshold that I've been told by all previous doctors, he said they were not up to date on the information. Now I'm scheduling another consultation for a second opinion. Any input is appreciated. Thanks.

Good morning

Things we have no control over, we have to act on.
You are lucky that this clinic is recognized as the best in the world.
So far, since 2006, I have had 6 heart surgeries and I am alive, and currently the anorisma is 4.8 cm.
In Germany, specifically in Berlin, they operate no earlier than 5.5 cm.
You have many years ahead of you before surgery and a fantastic opportunity.
Please think positively and do not burden yourself with something you have no control over.
Of course you can't work hard, lift heavy loads, please live healthily and enjoy life.

Kind regards
Zdzisław

Listen to your surgeon. Get the surgery. I suffered a complete aortic dissection in 2015. It was sudden and instantaneous. It was brutal and I nearly died. You do not want this to happen to you. Stop following your own instincts to avoid surgery and listen to your surgeon. I understand it’s scary but trust me when I say this it is way less scary to have scheduled surgery than it is to have this happen suddenly to you. You will not survive it. Listen to your surgeon and stop substituting your own confirmation bias to avoid that surgery. Your surgeon knows what he/she is talking about. Peace.

Thanks for sharing. What do you mean by 'not fully recovered'? My mum is 80 and possibly doing the surgery this week.

I am a 63 YO female. They found an Ascending aortic aneurysm incidentally, measuring 3.8. I prefer to "fix" the problem rather than taking Rx - which are just as risky as surgery. Who says prescriptions are the conservative route? The pharmaceutical industry? The side effect risk of drugs is real, and I don't wish to treat the symptoms only to find out I'll have to surgically address the AAA when I'm older. My father had an AAA. Do I need to get DNA testing to make a case? What surgical options do I have?

I asked the surgeon how was it that he operated on just a foot or so of my chest and knocked the stuffing out of the rest of me! Before surgery I jogged a bit over a mile around my neighborhood most days, weather permitting. Now I have trouble keeping up with the family when we walk through a shopping mall. Going up a flight of stairs takes me longer and I always make others go ahead. I went through cardio rehab (about 40 sessions) and then joined a health club to do the same exercise routine 4-6 days per week but it's just not helping. I was hoping to go skiing in Colorado this winter but that's definitely off the table.

I am at 4.5 cm stable the last 1-1/2 years. I was told by my Thoracic Surgery specialist (the one who does the operation) that the limit is 5.0 cm. They will not do it earlier because there is a risk of people not making it through the surgery and if its stays stable they just monitor the risk is a lot smaller. One the other hand the risk of rapture is higher when over 5.0 cm.

A 3.8 cm ascending aortic aneurysm is on the smaller side and, in most cases, doesn't require immediate surgery. The general approach is surveillance with imaging to track growth over time, since most aortic aneurysms don’t suddenly rupture unless they reach a much larger size, typically over 5.0–5.5 cm. That said, every case is different, and family history—especially if your father had an aneurysm—can be a factor in risk assessment.

Medication isn’t about "treating symptoms"; it's about reducing stress on the aortic wall to slow growth and prevent complications. Beta-blockers and ARBs, for example, have been shown in some studies to reduce aneurysm expansion rates. The risks of medications exist, of course, but they are generally low compared to the risks of early surgery. Surgery has its own set of serious risks, including stroke, infection, and complications related to bypass circulation. It's not that surgery isn’t an option—it’s that timing is everything.

Trust me, I had open-heart surgery to repair my burst aorta in 2015. It is an absolute nightmare. Recovery is long, painful, and physically and emotionally draining. If there had been any alternative, I would have taken it. I do not believe I would undergo open-heart surgery if it were merely optional. I’m also not sure you’re going to find a surgeon who will want to operate just because you say you want it. Most will follow the established guidelines, which weigh the risks of surgery against the risks of aneurysm progression.

Genetic testing could be useful if there’s a strong family history of connective tissue disorders (like Marfan or Loeys-Dietz syndrome), but it’s not necessary just to "make a case" for surgery. As for surgical options, the standard approach for an ascending aortic aneurysm is an open repair with a synthetic graft. If the aortic valve is involved, some patients may need valve-sparing root replacement (David procedure) or valve replacement, depending on the anatomy. Less invasive options like TEVAR aren’t typically used for ascending aneurysms yet.

Your best next step is to consult with a cardiothoracic surgeon who specializes in aortic disease. A detailed review of your imaging, family history, and overall health will give you a clearer picture of the right path forward.

Hello, I was recently diagnosed with a 4.2 ascending aorta dilation, Thoracic Aortic Aneurysm, I am waiting a second opinion from Mayo. In the interim, I do moderate exercise which includes, biking, weight strenghting classes where I use weights on a bar up to 20 pounds and single weights of up to 12 pounds in each hand; Zumba, Pilates, yoga, and cardio+resistance training. I was doing kick-boxing but stopped after the diagnosis. I am wondering if any of the other activities should stop as well.

Subject: Exercise & Your 4.2 cm Aortic Aneurysm

Hey,

First off, smart move getting a second opinion from Mayo. They’ll give you solid guidance. In the meantime, you need to modify your workouts to reduce strain on your aorta.

What to Avoid
• Heavy lifting (even with “moderate” weights like 20 lbs on a bar or 12 lbs per hand) – anything that causes you to bear down or hold your breath (Valsalva maneuver) is risky.
• High-intensity resistance training – especially anything explosive or involving sudden force (e.g., deadlifts, squats, overhead presses).
• Kickboxing was a good one to drop – the twisting, impact, and blood pressure spikes weren’t doing you any favors.

What’s Generally Safe
• Biking (as long as you keep effort moderate—no sprints or steep climbs).
• Yoga & Pilates (but avoid extreme backbends or positions that make you strain).
• Zumba & low-impact cardio (keep it at a steady, moderate pace—no HIIT-style bursts).

What You Should Do Now
• Stick to light resistance (bodyweight or very light weights) if you want to maintain muscle tone.
• Focus on aerobic exercise at a moderate intensity—this keeps your heart strong without dangerous BP spikes.
• Keep monitoring blood pressure during workouts; sudden spikes are what you want to avoid.

Until Mayo weighs in, err on the side of caution. A 4.2 cm aneurysm isn’t an emergency, but it’s big enough that you need to be mindful. If anything makes you feel lightheaded, short of breath, or just “off,” stop immediately.

Hope this helps—take care of that aorta. I suddenly and fully dissected in 2015. It’s no joke and you do not want to be in that place. Trust me. I would do what you can to reduce your stress and I would not be lifting anyway without a specific approval from a consulting thoracic surgeon with expertise in aorta repair.. Seriously peace.