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Should I get a second opinion about surgery?
Hi all, my name is Pattie. I was diagnosed Oct 2024 with giant cell arteritis which led to a CT scan. It was discovered that I have an ascending aortic aneurysm, 4.8cm to 5.3cm (depending on who's measuring). I just finished prednisone treatment for the GCA, supposedly it's in remission now. I was referred to cardiovascular thoracic surgeon for the aneurysm. She recommended open heart surgery to repair it with a graft. My valve is normal tricuspid. She's "calling" the aneurysm size 5.0, as she is "taking an average" between the measurements of 4.8-5.3 (obtained by 2 radiologists and an interventional cardiologist). Not clear if she actually measured it on imaging herself. She said my surgery should be "sooner rather than later" but that it's not "emergent", although she doesn't recommend a period of "watchful waiting". She's been pretty vague on the timing. Her rationale for surgery: She says 5.0 meets threshold for surgery, and that the "integrity of my vascular tissue may be compromised" due to GCA, and also family history... my father died at 63 from sudden cardiac death (unknown if caused by aneurysm, although he had hypertension and atherosclerosis). I also have hypertension (now controlled with BP meds).
I am 75 years old, 5'9" tall, very slim. I've read about aneurysm size (and also a person's height/body surface area) and such conflicting information about when it's appropriate to intervene surgically, including reports from people in this forum who have lived with their aneurysms that have been stable at larger sizes for years etc.
Getting very anxious about who to believe/trust. I am terrified at the thought of open heart surgery and the extensive recovery period. The hospital here is nice, the surgeon seems nice, but she said the hospital only does 10-12 aorta surgeries a year. I've done extensive research and reading. Wondering if I should seek out a second opinion from a reputable, high volume heart center. I'm in California... Stanford, UCSF, Cedars Sinai in LA all have second opinion services available online (you get a written report), but it's expensive of course. I suspect I'm probably going to get the same recommendation from other professionals, telling me to proceed with surgery. Does anyone want to weigh in on whether they think it's worth the hassle and expense for me to get a second opinion?
I'm just a bundle of nerves and so undecided about everything. Thanks in advance for any advice that's offered!
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Just wanted to update with good news! I got an in-person appt with Dr Fischbein on July 2. He's the Stanford cardiothoracic surgeon who was mentioned and recommended. It's about a 2 hr drive for me to Stanford from Monterey, so not too terribly far. I'm so grateful for this opportunity and I feel very positive now about pursuing 2nd opinion. Can't believe I was even hesitant before! My fantasy hope is that he might tell me we can do "watchful waiting" for my 5.0-5.3 cm aneurysm with periodic CT scans to see if it's stable in size... The more realistic part of me thinks he will probably recommend surgery. But whatever the outcome, ultimately, I'm proud of myself for seeking additional expert consultation. Thanks for all who weighed in on the importance of getting 2nd opinion. All of the input convinced me to try! I'll update here with what Dr Fischbein recommends after my appt on July 2. Wish me luck!!
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7 ReactionsMy doctor told me that, absent any other complicating factors, between 5.0 and 5.5 is normally a bit of a "gray" area where a patient's own views should take precedence. The risk of a dissection in that range are still comparatively low, or as you first doctor said, not "emergent." It's once you hit 5.5 that the risk of dissection starts to go up exponentially. However, the fact that you had GCA does seem significant and would seem to raise your risk. Fundamentally, it's your choice. If you were younger, below 60 like me, then the surgery option might seem more compelling, but as you get older, the recovery from major surgery becomes more challenging, especially if you have any other health conditions. One comment: a variation between 4.8 (below surgical threshold) and 5.3 is pretty wide. I would think that the doctor would want the most precise measurement possible using a gated CT scan with contrast, if that has not already occurred.
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2 ReactionsYou’ve mentioned so many things that I’ve been thinking too! I’ve really wondered about the precision factor when it comes to measurement of the aneurysm. How can there be such a discrepancy in size when the same imaging is measured by different professionals? And especially when size is the defining criterion for surgical intervention, it seems to me that obtaining a very accurate measurement is crucial. I’ve read briefly about gated CT
scans. Seems like they’re hard to get? Maybe not widely available due to needing special equipment and expertise? Or maybe not covered by Medicare? In any case, no, I haven’t had one but it’s certainly a consideration. I’ll ask the cardiothoracic surgeon at my appointment on July 2. Thanks so much for your insight and thoughtful input!
There are different diagnostic tools (CT scan, echo, MRI, etc.) that can result in different values. I understand that the gated CT scan is the most accurate tool. In my case, my condition was initially caught with an inexpensive $99 non-gated CT scan that I had done to check for possible calcification. I then had a gated CT scan with contrast 6 months later and it showed at 0.2 cm difference, basically because it eliminated the inaccuracy which can result from the movement of the heart. I would think Stanford would certainly have those resources available since it is a leader in the field. So, it's worth asking about. I don't know what the insurance coverage for such procedures is under Medicare since mine was done under my employer-provided insurance plan.
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3 ReactionsVery interesting! Much appreciate the additional info, thanks!