Personalised external aortic root support

The personalised external aortic root support (PEARS) is a medical procedure designed to manage aortic root aneurysms, particularly in patients with connective tissue disorders such as Marfan syndrome. This technique involves the use of a bespoke microporous textile mesh jacket, tailored precisely to the dimensions of an individual's aorta, providing an alternative to conventional surgical methods.^[1]

PEARS is used to support the aortic root and the ascending aorta in patients with aortic root aneurysms. It is particularly beneficial for patients with connective tissue disorders such as Marfan syndrome, Loeys–Dietz syndrome, or those with a bicuspid aortic valve. The procedure helps to prevent aortic root expansion and aortic dissection, which can lead to severe complications such as aortic valve regurgitation, rupture, and death.^[2][3]

The PEARS procedure begins with a detailed CT scan of the patient's aorta to gather precise measurements. These measurements are then used with computer-aided design to create a 3D-printed plastic model of the patient's aorta. This model serves as a template for manufacturing the ExoVasc PEARS implant, which is made from a soft and pliable biocompatible textile, typically polyethylene terephthalate.^{[citation needed]}

The implantation process involves opening the chest through the breastbone and wrapping the mesh around the outside of the aorta at the part closest to the heart. This mesh provides graduated support to the aortic root and ascending aorta, reducing the risk of aortic root expansion and aortic dissection.^[1][4]

In the aortic PEARS procedure, the ExoVasc PEARS supports the dilated aorta in patients with connective tissue disorders. This procedure is less invasive than traditional surgical options and does not require cardiopulmonary bypass.^[5]

The Ross-PEARS procedure involves replacing a diseased aortic valve with the patient's own healthy pulmonary valve, which is then supported by an ExoVasc PEARS. This procedure is particularly useful for patients who require aortic valve replacement but wish to avoid mechanical valve replacement and the associated need for anticoagulation.^[6]

One of the significant advantages of the PEARS procedure is that it does not require cardiopulmonary bypass, although it has been used occasionally as an adjunct. The aorta is not clamped or opened, so there is no myocardial ischemia involved. Additionally, there is no routine requirement for blood products, nor is there a risk of cerebral ischemia or embolus. This makes the procedure less invasive and reduces the recovery time for patients.^[7]

Clinical outcomes for PEARS have been favorable. In over 200 patient-years of follow up, there have been no untoward events related to the aortic wall or valve after PEARS. When compared with data for either the Bentall procedure or valve-sparing aortic root replacement, outcomes so far are very favorable for external support.^[7]

The concept of PEARS was first proposed in 2000 by Tal Golesworthy, an engineer with familial Marfan syndrome and an aortic root aneurysm. Golesworthy, driven by the need for a less invasive treatment option, assembled a research and development team to bring his idea to fruition. Collaborating with surgeons, the first clinical implementation of PEARS occurred in 2004, with Golesworthy himself being the first patient to undergo the procedure.^[8]

Since its inception, the PEARS procedure has been performed in several hospitals across England and Belgium, demonstrating its potential as a viable treatment option. The procedure has undergone health technology appraisal by the National Institute for Health and Care Excellence (NICE), further validating its efficacy and safety.^[3]

• Aortic aneurysm
• Marfan syndrome
• Connective tissue
• Cardiopulmonary bypass

• Treasure, Tom; Petrou, Mario; Rosendahl, Ulrich; Austin, Conal; Rega, Filip; Pirk, Jan; Pepper, John (September 2016). "Personalized external aortic root support: a review of the current status". European Journal of Cardio-Thoracic Surgery. 50 (3): 400–404. doi:10.1093/ejcts/ezw078. PMID 27032474.
• Austin, C.; Mathur, S.K.; Pepper, J. (October 2016). "Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4". International Journal of Cardiology. 220: 772–774. doi:10.1016/j.ijcard.2016.06.248. PMID 27393865.