Personalised External Aortic Root Support

The ExoVasc® Personalised External Aortic Root Support (PEARS) is a new conservative treatment to manage aortic dilation and dissection in patients with Marfan and other syndromes.

For the operation of PEARS, the dimensions of the individual patient’s aorta are taken from the preoperative CT digital images. These are then used to make a three-dimensional model of the patient’s aorta in computer aided design (CAD) and utilising 3-D printing techniques a physical model is produced. On this physical model an external support of a medical grade polymer fabric mesh with 0.7 mm pore size is made.

Via open chest surgery the ExoVasc™ support is placed around the ascending aorta where it provides support to the patient’s own aorta and aortic valve and is designed to prevent enlargement and rupture. Due to the variation in size and shape of the aortic root in patients the custom-made external support is an essential component if this approach to the prevention of aortic dissection is adopted.

What are the benefits?

It takes a relatively short time to implant, around two hours for the full surgery. This is considerably less time than the conventional aortic root replacement, which takes around 4 to 7 hours. Cardiopulmonary bypass is not usually necessary as the procedure is carried out on the beating heart. Additionally, it offers freedom from anticoagulation post surgery as the aorta and aortic valve remain intact.

Are there any alternatives?

Three forms of surgery are now available: total root replacement (TRR) with a valved conduit, valve sparing root replacement (VSRR) and PEARS.

TRR can be performed irrespective of aortic dimensions and a valve replacement is a secure and near certain means of correcting aortic valve regurgitation but has small thromboembolic and bleeding risks if a mechanical device is chosen. For this reason root replacement with a biological conduit (Freestyle®) is the preferred approach at RBH. VSRR offers freedom from anticoagulation and attendant risks of bleeding but every year 1.3 percent of cases require a repeat operation. While this may seem a low figure, in a young Marfan patient this means that more than 25% will require another operation on their aortic valve within 20 years.

PEARS includes the advantages of VSRR while avoiding myocardial ischemia and usually cardiopulmonary bypass.

Consultants linked to treatment

Mr J Andreas Hoschtitzky, consultant paediatric and adult cardiac surgeon

Location where service is offered

Royal Brompton Hospital

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