Bicuspid aneurysm size guideline

[dixitworld]

I thought I tried pretty seriously above where I said:

have you actually tried reflecting on that in a serious way or are you just "seeking some magic injection" like morphine where you don't have to do anything yourself?

That's not how life actually works.

Best Wishes

I did very well but kind of my anxiety is top of the roof where at one time I was about to go to emergency. My mind keep saying why the surgery is risk is 1 percent per year now when the surgery risk is 2-3 percent. However I wanted to do surgery max till 5.8-5?9 to avoid 6cm threshold. And for me the size of aorta itself is messed up as cardiologist saying 5.7 and surgeon measuring 3 D model as 5.5

 

[dixitworld]

I did very well but kind of my anxiety is top of the roof where at one time I was about to go to emergency. My mind keep saying why the surgery is risk is 1 percent per year now when the surgery risk is 2-3 percent. However I wanted to do surgery max till 5.8-5?9 to avoid 6cm threshold. And for me the size of aorta itself is messed up as cardiologist saying 5.7 and surgeon measuring 3 D model as 5.5

Got this one bicuspid aneurysm study at https://www.jacc.org/doi/10.1016/j.jacadv.2023.100626 where though sample size is modest shows risks from 5.1-5.5, 5.5-5?9 and 6 as 0.4,0.7 and 3 respectively annually
So still not able to understand why such intrusive surgery is recommended

 

[dixitworld]

Got this one bicuspid aneurysm study at https://www.jacc.org/doi/10.1016/j.jacadv.2023.100626 where though sample size is modest shows risks from 5.1-5.5, 5.5-5?9 and 6 as 0.4,0.7 and 3 respectively annually
So still not able to understand why such intrusive surgery is recommended

Pellicle can you please review above study and provide your expert feedback on this also

 

[Gail in Ca]

My story might help you make your decision. At 34 my aneurysm was discovered and it was at 6. I needed surgery and waited 6 weeks for that surgery. My aorta fell apart in the surgeon’s hands. I later read the surgical summary and it was really at 7.
I always felt good about each of my surgeries because my surgeons were so confident that they made me confident that I would survive.
It seems they still can’t see the actual shape the aortic tissue is in and so only go by how big they think it is.
All the best for you in making your decision. If you choose a great, highly recommended surgeon at a top hospital, I think you will come through your surgery just fine!

 

[dixitworld]

How long back you had surgery? And any issues post surgery since then?
My biggest fear is that after this surgery any comorbidities like renal failure, brain dysfunction etc (mortality is kind of out of hand) and probability of third surgery sooner than later.

I see even in bentall procedure there are many reasons for surgeries down the road again and person like me who is highly nervous and anxious , keep debating my mind to buy more time here from god till 5.9 cm or so before my second surgery

My story might help you make your decision. At 34 my aneurysm was discovered and it was at 6. I needed surgery and waited 6 weeks for that surgery. My aorta fell apart in the surgeon’s hands. I later read the surgical summary and it was really at 7.
I always felt good about each of my surgeries because my surgeons were so confident that they made me confident that I would survive.
It seems they still can’t see the actual shape the aortic tissue is in and so only go by how big they think it is.
All the best for you in making your decision. If you choose a great, highly recommended surgeon at a top hospital, I think you will come through your surgery just fine!

 

[Gail in Ca]

My last surgery was 1/2009. I haven’t had any issues with the aortic valve in graft the surgeon created for me during the surgery. I now have mitral valve issues but the consensus is I have time before I need another procedure, maybe never.
If the surgeon you want says it’s time, then follow that advice and do it.

 

[V__]

I see even in bentall procedure there are many reasons for surgeries down the road again and person like me who is highly nervous and anxious , keep debating my mind to buy more time here from god till 5.9 cm or so before my second surgery

I think you are trying to over-optimize the situation. I doubt you have precise enough information to fine-tune these steps.

Every action has a risk associated with it. But you have to live your life, and make decisions, even if they have risks and consequences. E.g. waiting until 5.9 cm has its own risk. (It already exists now, and the progression may not be gradual in the future.) And spending time going back and forth between the different options will "cost" you the "opportunity loss" with getting something else done or spending time with your family. Making the decision (whatever it is) and living with it might work out better, if you can do it.

 

[dornole]

Got this one bicuspid aneurysm study at https://www.jacc.org/doi/10.1016/j.jacadv.2023.100626 where though sample size is modest shows risks from 5.1-5.5, 5.5-5?9 and 6 as 0.4,0.7 and 3 respectively annually
So still not able to understand why such intrusive surgery is recommended

Because they look at all the studies and the current standard of care vs looking for and cherry picking only the ones that suggest waiting.

You have said several times that you have anxiety. I have depression. I account for this in decision making because I know moods can drive me in an illogical direction. I deliberately and mindfully placed my trust in published guidelines and my docs, and verified with a second opinion when they told me it was time for surgery. I made that decision. If more stuff goes wrong I will deal with it then.

If you don’t trust your cardiologist and surgeon’s opinion over your anxiety brain I’m not sure what else anyone can say here. I am wondering what your wife / family says you should do.