Highlights
- •A comprehensive overview of a novel management option for a patient with thoracic aortic aneurysm and a connective tissue aortopathy: Personalized External Aortic Root Support (PEARS).
- •Includes a description of the key principles of patient selection, surgical steps and postoperative care.
- •Detailed figures describing the implantation of a PEARS device with complementary video clips.
The Personalized External Aortic Root Support (PEARS) procedure offers a novel alternative
to traditional surgical options for aortic root aneurysms in patients with connective
tissue disorders and neo-aortic root dilatation following the arterial switch or Ross
procedures. It has a lower biological insult than conventional surgical management
with shorter operating times and avoidance of cardiopulmonary bypass and cardioplegic
arrest in most cases. The patient's own valve, root architecture, and blood to vessel
wall interface are maintained. Avoidance of mechanical valve replacement negates the
requirement for anticoagulation which is especially beneficial in young patients.
This article aims to describe the key principles and operative steps for implanting
the PEARS device. We describe the technical steps applicable to all PEARS implants
and have included our tips and tricks at each stage. We consider PEARS to be a valid
alternative therapeutic option for surgical teams managing patients with aortopathies.
Keywords
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References
- Valve-sparing aortic root surgery in children and adults with congenital heart disease.J Thorac Cardiovasc Surg. 2020;
- Manufacturing and placing a bespoke support for the Marfan aortic root: Description of the method and technical results and status at one year for the first ten patients.Interact Cardiovasc Thorac Surg. 2010; 10: 360-365
- Surgical management of aortic root disease in Marfan syndrome: A systematic review and meta-analysis.Heart (British Cardiac Society). 2011; 97: 955-958
- ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2873-2926
- A method for early evaluation of a recently introduced technology by deriving a comparative group from existing clinical data: A case study in external support of the Marfan aortic root.BMJ Open. 2012; 2e000725
- External aortic support for people with Marfan's syndrome.BMJ (Clinical research ed). 2010; 340: c1692
- External aortic root support: NICE guidance.Heart (British Cardiac Society). 2012; 98: 65-68
Treasure T, Takkenberg JJM, Golesworthy T, et al. 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. 2014;100:969-75.
- Personalized external aortic root support: A review of the current status.Eur J Cardiothorac Surg. 2016; 50: 400-404
- External aortic root support: A histological and mechanical study in sheep.Interact Cardiovasc Thorac Surg. 2013; 17: 334-339
- Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4.Int J Cardiol. 2016; 220: 772-774
- Histology of a Marfan aorta 4.5 years after personalized external aortic root support.Eur J Cardiothorac Surg. 2015; 48: 502-505
- Personalised External Aortic Root Support (PEARS) compared with alternatives for people with life-threatening genetically determined aneurysms of the aortic root.Diseases (Basel, Switzerland). 2015; 3: 2-14
Article info
Publication history
Published online: June 21, 2021
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Identification
Copyright
© 2021 Published by Elsevier Inc.
