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Publication Detail
Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Comparative Study
  • Authors:
    Treasure T, Takkenberg JJM, Golesworthy T, Rega F, Petrou M, Rosendahl U, Mohiaddin R, Rubens M, Thornton W, Lees B, Pepper J
  • Publication date:
  • Pagination:
    969, 975
  • Journal:
  • Volume:
  • Issue:
  • Status:
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  • Keywords:
    Adult, Aortic Aneurysm, Aortic Valve, Belgium, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Computer-Aided Design, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation, Humans, Intention to Treat Analysis, London, Magnetic Resonance Angiography, Male, Marfan Syndrome, Precision Medicine, Prospective Studies, Prosthesis Design, Surgery, Computer-Assisted, Surgical Mesh, Time Factors, Treatment Outcome, Young Adult
OBJECTIVE: Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation. In 2004, a total root and valve-sparing procedure, personalised external aortic support, was introduced. We report here results among the first 30 recipients. METHODS: From cross-sectional digital images, the patient's own aorta is modelled by computer aided design and a replica is made in thermoplastic by rapid prototyping. On this, a personalised support of a macroporous polymer mesh is manufactured. The mesh is positioned around the aorta, closely applied from the aortoventricular junction to beyond the brachiocephalic artery. The operation is performed with a beating heart and usually without cardiopulmonary bypass. RESULTS: Between 2004 and 2011, 30 patients, median age 28 years (IQR 20-44) had this operation and have been prospectively followed for 1.4-8.8 years by February 2013. During a total of 133 patient-years there were no deaths or cerebrovascular, aortic or valve-related events. These early outcomes are better than published results for the more radical extirpative root replacement operations. CONCLUSIONS: The aortic valve, the root architecture, and the blood/endothelia interface are conserved. The perioperative burden is less and there has been freedom from aortic and valvular events. A prospective comparative study is planned.
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