What is a personalised external aortic root support (PEARS)?

The ExoVasc® personalised external aortic root support (PEARS) is a revolutionary new device.

It treats and manages aortic dilation and dissection in patients with Marfan syndrome – a genetic disorder of the connective tissue – and other syndromes.

What to expect

For the operation of PEARS, the dimensions of the individual patient’s aorta are taken from the pre-operative digital images taken from a CT (computerised tomography) scan.

These are then used to make a three-dimensional (3D) model of the patient’s aorta in computer aided design (CAD). Then, utilising 3D 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.

Surgery to support the aorta

Through open chest surgery, the ExoVasc® support is placed around the ascending aorta.

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 to adopt this approach to the prevention of aortic dissection.

What are the benefits of PEARS?

It takes a relatively short amount of time to implant the ExoVasc® personalised external aortic root support (PEARS) – around two hours for the full surgery.

This is considerably less time than the conventional aortic root replacement, which takes around four to seven 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 to PEARS?

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

Total root replacement

This can be performed irrespective of aortic dimensions. A valve replacement is a secure and near-certain means of correcting aortic valve regurgitation. However, it 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 Royal Brompton and Harefield hospitals.

Valve sparing root replacement (VSRR)

This offers freedom from anticoagulation and attendant risks of bleeding. However, every year 1.3 per cent of cases require a repeat operation. While this may seem a low figure, in a young Marfan patient this means that more than 25 per cent will require another operation on their aortic valve within 20 years.

Why choose PEARS?

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

Our cardiac surgery specialists

Royal Brompton and Harefield hospitals are home to the following specialists who offer PEARS treatment: