How will my doctor decide if I need aortic surgery?

There are cases where surgery is necessary, but this is determined on an individual basis. The size of the aneurysm is an important factor, but other variables also contribute to the surgeon's decision-making process. In the first portion of the aorta (the root), for example, an aneurysm that is over 5 cm begins the conversation about an operation. We then consider the function of the aortic valve. If the valve is diseased, meaning it leaks or is stuck (stenotic) we then may advise surgery. If the valve is a bicuspid valve (meaning it has two leaflets, rather than three), we would advocate for an operation. If a patient has evidence of a connective tissue disease, such as Marfan syndrome, or a family history of an aortic problem (aneurysm or dissection), we recommend surgery.

On the other hand, if a patient has been followed with CT scans for some time, and the aorta is stable, we may continue to recommend follow-up instead of surgical intervention. In a large individual, a 5 cm aneurysm may not be as concerning as it is in a smaller individual. In such cases we may not recommend any further treatment at all. We prefer to have an in-depth conversation and look at all of the studies with the patient to formulate an individual plan that will provide assurance and safety.

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