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Heart. 2014 Jun;100(12):969-75. doi: 10.1136/heartjnl-2013-304913. Epub 2014 Jan 6.

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.

Author information

1
Clinical Operational Research Unit, UCL, London, UK.
2
Department of CardioThoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
3
Exstent Ltd, Tewkesbury, UK.
4
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
5
John Radcliffe Hospital, Oxford, UK.
6
Department of Cardiac Surgery, Royal Brompton Hospital, London, UK.
7
Department of Cardiac MRI, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK.
8
Department of Radiology, Royal Brompton Hospital, London, UK.
9
CTEU, Royal Brompton Hospital, London, UK.
10
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.

Abstract

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 This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation.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.

PMID:
24395977
PMCID:
PMC4033204
DOI:
10.1136/heartjnl-2013-304913
[Indexed for MEDLINE]
Free PMC Article

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