When to get Surgery for an Aortic Aneurysm

It's been about 9 months since my open heart surgery for an aortic aneurysm, and I'm still coming across good information regarding the condition. Last week a gentleman who found my blog emailed me and told me about the Cleveland Clinic formula for measuring an aortic aneurysm and helping to predict the right time for surgery.

An aorta that is enlarged and forming an aneurysm can be repaired, but at Cleveland Clinic we more often replace the damaged section with a section of plastic tubing that is sewn into position. The timing for repair of an aortic aneurysm is critical. When the valve is faulty and the aorta has enlarged to greater than 4.5 cm, we repair the aorta at the same time we repair or replace the valve. If the aorta has enlarged but the valve is still good, the optimal time to repair the aorta varies. At Cleveland Clinic, we have developed a special mathematical formula we use to determine this, based on the patient’s height and weight and the size of the aorta - surgery is usually recommended when the aortic cross sectional area in square centimeters, divided by the patient's height in meters is more than 10.

While I was researching my own condition last year I found this interesting study: "Novel Measurement of Relative Aortic Size Predicts Rupture of Thoracic Aortic Aneurysms". Coincidentally when I finally went in for my surgery at Columbia Presbyterian, I got a chance to meet the doctor who conducted this study. Doctor Ryan Davies worked for my surgeon Dr. Allan Stewart. It was interesting meeting another guy who lived eat and breathed aortic surgery and had contributed so much to the field.

For many months leading up to my surgery I tried to avoid it and come up with any reason that would rationalize my condition. When I was first diagnosed with an aneurysm I used Dr. Davie's study above to try and rationalize my risk for aortic dissection. I was able to point out on the chart in the study to anyone who would listen, that I was not in a high risk category because of my body surface area and because I was a big guy relative to my aortic size. As time went on though, my aneurysm had gotten so large that I didn't have much to support my plight of avoiding surgery. By the time I came to terms with going under the knife, both of the studies above would have suggested immediate surgery. My aneurysm had started at about 5.3cm when I was diagnosed and within a year had blown up to 6.5cm. Calculate that on the Cleveland Clinic predictor above :)

The long and short of it is that if you're diagnosed with an aortic aneurysm, do your diligence. Become a research-a-holic and get as much information, and as many opinions as you can. Keep an open mind and opt for surgery when and only when you have done diligence.  Make an informed decision taking into account all of your findings and make it with the cooperation of your doctor(s).  I would not advise pushing the envelope as close as I did :)


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