Brief Answer:
Needs assessment and clinical correlation

Detailed Answer:
Thank you for asking!
Aortic aneurysm is by definition beyond 4.5cm. between it and 3.5 is is simple aortic dilation a condition less severe than aneurysm. Aneurysms are fatal if they rupture, And there are the odds for it. If the diameter is under 4cm, the odds of rupturing in 5 years are zero percent. If it is between 4 and 5.9 cm. then the odds increase to 16 % ( that is every 16 people out of 100 will be at risk to rupture in next 5 years). before talking about odds of survival, ANswer my few questions.
-Do you have any chest back or abdominal pains.
-Do you have shortness of breath?
-Any blood in sputum or vomit or stools?
- Any hoarseness in voice?
-Do you smoke?
-Are you hypertensive?
-Any connective tissue disease like MArfan syndrome, Ehlers Danlos syndrome etc. -Any rheumatologic disorders, such as giant cell arteritis, Takayasu arteritis, and psoriatic arthritis.?
-Any Syphilis history?
-Are there any bleeding tendencies? deranged clotting profiles?
-Is your cardiac status Ok? MI history etc
-Are your kidneys fine?
-How is your lipid profile? is it atherosclerotic or deranged?
if the answers to these question are affirmative and good then less are the chances of trouble. The goal of medical therapy is to reduce the pulse pressure (dP/dt) within the aorta. Reducing the heart rate, the blood pressure (BP), pain, and anxiety are the mainstays of therapy.
Now how bad is the tear depends on the extent of damage which needs to be assessed by an endovascular surgeon with some work up like radiography, ultrasonography, angiography and MRI etc and then managing accordingly as per needs.Might need a surgical interventions or conservative management after complete assessment of the tear.
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 invasive procedures so i will say stenting but it has been shown that open heart procedures last a bit longer but with their own pros and cons.Meanwhile continue on medications. Keep a regular check on your hypertension. Avoid tobacco in any form.Add some beta blockers and vasodilators for medications and you will be out of woods.
I hope it helps and you see it in a right perspective. Get to an endovascular surgeon and let him assess the damage and help you accordingly.
take good care of yourself and Dont forget to close the discussion please.
May the odds be ever in your favour.
Regards
S Khan

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