Brief Answer:
Procedure depends on situation.Medical enough
Detailed Answer:
Hello there!
I think you should continue on medications.
Keep a regular check on your hypertenion. Avoid tobacco in any form.Add some beta blockers and vasodilators for medications and you will be out of woods.
As we discussed at your level odds are just 16 % of rupture. we recommend surgery when the aneurysm pasts beyond 5.5 cm. But you are 4.4 from long time.It wont come to that trust me, Just follow the precautions i mentioned and you will stay out of the woods. Now in your case as you are 4.4 cm dilated for years and you can control it medically i dont think you should undrgo through surgery at all. As at the age of 60 years surgery will complicate the issues and then comes the warfarins and maintenance,But if you want surgery there are 8 options to do that. Discuss them with your surgeon and see which comes out best for you.
Surgical treatment of ascending aortic aneurysms depends on the extent of the aneurysm both proximally (eg, involvement of the
aortic valve, annulus, sinuses of Valsalva, sinotubular junction, coronary orifices) and distally (eg, involvement to the level of the innominate artery). The choice of operation also depends on the underlying pathology of the disease, the patient's life expectancy, the desired anticoagulation status, and the surgeon's experience and preference.
1)Ascending aortic aneurysms with normal aortic valve leaflets, annulus, and sinuses of Valsalva are typically replaced with a simple supracoronary Dacron tube graft from the sinotubular junction to the origin of the innominate artery, with the patient under
cardiopulmonary bypass.( the one which you mentioned as open heart surgery)
2)If the aortic valve is diseased but the aortic sinuses and annulus are normal, the aortic valve is replaced separately and the ascending aortic aneurysm is replaced with a supracoronary synthetic graft, leaving the coronary arteries intact (ie, Wheat procedure).
Sinus of Valsalva aneurysms with normal aortic valve leaflets and
aortic insufficiency due to dilated sinuses may be repaired with a valve-sparing aortic root replacement. Two valve-sparing procedures have been developed:
a)the remodeling method and
b)the reimplantation method.
a)The remodeling method involves resecting the aneurysmal sinus tissue while maintaining the tissue along the valve leaflets and scalloping the Dacron graft to form new sinuses to remodel the root.
b)The reimplantation method involves reimplanting the scalloped native valve into the Dacron graft. Both require reimplantation of the coronary ostia into the Dacron graft.
3)Patients with an abnormal aortic valve and aortic root require aortic root replacement (ARR).
4)In nonelderly patients who can undergo anticoagulation with reasonable safety, the aortic root may be replaced with a composite valve-graft consisting of a mechanical valve inserted into a Dacron graft coronary artery reimplantation (eg, classic or modified Bentall procedure, Cabrol procedure).
5)For elderly patients, young active patients who do not desire anticoagulation, women of childbearing age, and patients with contraindications to warfarin, the options include stentless porcine roots, aortic homografts, and pulmonary autografts (ie, XXXXXXX procedure).
6) For elderly patients who cannot undergo a complex operation, another option is reduction aortoplasty (ie, wrapping of the
ascending aorta with a prosthetic graft).
7)Patients with
Marfan syndrome have abnormal aortas and cannot undergo tube graft replacement alone. They must have either a valve-sparing aortic root replacement or a complete aortic root replacement.
8)Aortic root replacement with a homograft is ideal in the setting of aortic root abscess from
endocarditis.
Now out of these 8 ways in different circumstances Procedures like open heart surgery and stenting. I believe to choose minimal invsive procedures so i will say stenting but it has been shown that open heart procedures last abit longer but with their own pros and conses.
I hope you know what to do. Keep Asking if you need any thing further from me. I would be glad to help. Otherwise kindly close the discussion and rate the answer as per your experience
Cheers
Khan
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