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Two opposing recommendations on surgery
I am 57 and my aneurysm was discovered four years ago. My aneurysm grew this past year 0.4cm to 5.0cm and is 11cm in length. My heart surgeon is still in the wait it out mode but I went for a second opinion and this new doctor is telling me my risk of dissection with these measurements is 12-15% versus the risk of death from the surgery < 1%. He recommends I have the surgery and would not wait. So I have to decide whether to have the surgery sooner rather than later. I know I am delaying the inevitable but I am going for a third opinion on May 29. Not sure that changes the fact that I still need to make a decision. Like others have said the waiting is tough and puts your life on hold. That’s it just sharing. Thanks
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I am 60 and I survived an ascending aortic dissection 10 years ago. It was a nightmare and I barely survived. I would not recommend it for anyone. The chance of surviving a sudden dissection are slim if you are not lucky enough to be close to a major surgical center with the right aortic expert thoracic surgeon ready to go. I would not chance it knowing what I know now. I did not know that I had a problem until I had a problem.
You have the benefit of knowing that you have an aneurysm, which is at surgical levels now that it's at 5 cm. If it were me, I would have that surgery tomorrow. A planned surgery has much better outcomes than an emergent surgery like mine. I know that it's a daunting decision to make, but you need to listen to your surgical team and make the decision.
Think of it this way: it's sort of like having a huge bulge in the side of your tire and then deciding you're just going to continue to drive on it until something happens and hope for the best, as opposed to proactively getting the tire repaired while you're in town, near a shop that can handle it, and that has all the parts available to deal with it.
No one can make the decision for you, but I will tell you that I most certainly would have undergone planned surgery long before I would have waited for an emergency surgery when I was 1600 miles from home and in a hotel room on business in the middle of the night in San Diego. Peace.
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6 ReactionsHight and size of aneurysm/growth of aneurysm (https://www.jtcvs.org/article/S0022-5223(17)32769-1/fulltext) seems to be the gold standard for risk determination these days. It might be worth looking at it. I know being taller my risk of dissection is technically lower with a tricuspid valve and if I have slow growth. The older way of judging to wait or do surgery was body size which does not to be as accurate. So it probably depends on which scale the doctor is using for recommendation
Given the rate of growth and size, I tend to think the 2nd surgeon is correct. The key is to have an experienced surgeon, team and center.
I got 2 opposite opinions from surgeons under the same university hospital affiliation. First one said ohs was only option. Second one said no surgery needed, only cath and keep an eye on valves. Second one said tavr would be an option.
Obviously, a third opinion is in order.