Should I push to replace my mid ascending aorta?

[tommyboy14]

I am just going to add that the definition of aneurysm varies by age. A 50mm Aorta in an 80-year old would be considered normal, but indication for replacement in a 40-year old.

This article has a useful table:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461294/

The article says:

According to the classic understanding, a diameter increase of 50% marks the borderline between ectasia and aneurysm—the threshold at which a dilated ascending aorta/root should be considered an aneurysm, therefore, is

• 
  ~40 mm in a 20-year-old
• 
  ~ 45 mm in a 40-year-old
• 
  ~ 50 mm in a 60-year-old
• 
  ~ 55 mm in an 80-year old

 

[tommyboy14]

@Nesphito I think it is very sensible of your surgeon to make the call once he has opened you up. From my personal experience, the measurements can be different once they open you up. My measurements were around 4.5cm. When I had surgery three months later, it was above 5cm in the widest section. I was 34 at the time. Either measurements via Cather are not very accurate or I just got very lucky that I was operated on right before it raptured.

So of course it is the surgeon;s call, but perhaps you can indicate to him that if there is any doubt in this mind, your preference is to have a one and done and hence to replace the Aorta as well. I will also say, if you look at this influential study by Dr. David, the inventor of valve sparing,

https://www.jtcvs.org/article/S0022-5223(04)00984-5/fulltext

You can see below that biscupid patients without root replacement with greater than 4.5cm aorta, only began to have aneurysm re-intervention after 5 years. So any study you should look at should have a long follow up. I would not be guided by studies with short follow up.

Best of luck in your surgery.

 

[Survived03]

I understand now. Thanks and good luck. Let me know if I can help.

 

[Gail in Ca]

My aneurysm measurement was 6 before surgery. When I read the notes after surgery, it was apparently 7. It fell apart in my surgeon’s hands when he was going to cut it and place a graft inside then close it. He had to cut it out and just do the graft along with valve replacement.
That was at Stanford Hospital when I was 34yo. At 54yo, I had to have it removed and replaced with a valve in hemashield graft after endocarditis did a number on me. My surgeon the first time might not have done too many AA on someone my age. I didn’t specifically ask about just the aneurysm part of it. He was very confident about doing my surgery, but the aorta falling apart was not what he expected.
My subsequent surgeries were done by the best, most experienced surgeon at Stanford. I had a great cardiologist advocating for that surgeon to do my repeats.