For the operation of 'personalized external aortic support' (PEARS), the dimensions of the individual patient's aorta are taken from the preoperative MRI or CT digital images. They are used in computer-aided design to make a three-dimensional computer image of the individual patient's aorta. A physical model of the patient's aorta is made of thermoplastic, using a standard engineering process of rapid prototyping. On this physical model is manufactured an external support made of a medical grade polymer fabric mesh with 0.7 mm pore size. This fabric is placed around the ascending aorta from the aortoventricular junction to beyond the brachiocephalic artery. Follow-up is complete for the first 34 patients (June 2004 to November 2012) to a total of 127 patient-years. Since we submitted this paper, we have had an early death (the 34th patient) as a result of intraoperative injury to the left main coronary artery. The remaining 33 patients are alive and well from 3 to 103 months free from aortic, aortic valve or device-related events.