Personalized external aortic root support: a review of the current status

Abstract

Personalized external aortic root support (PEARS) is an emerging technology. It is a pre-emptive operation to halt aortic root expansion and maintain aortic valve function in Marfan syndrome and is also applicable to aortic root aneurysms of other aetiologies. To fully evaluate PEARS, awareness of all those who advise these patients is necessary to ensure that patients are fully informed of the alternative operations, to carefully build experience, to ensure safety and quality and to monitor outcomes. Herein, we present a summary of published methods and outcomes and the arrangements in place for fuller evaluation.

Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old

“…The individual's aortic root is replicated by a 3-dimensional printed model to produce an individualized polymer mesh sleeve, which is wrapped around the aorta. Over a 12-year period [2004-2016] more than 60 patients were treated with PEARS in six centers (4).…”

Practical clinical applications of 3-D printing in cardiovascular surgery

“…The digital imaging data may be derived from computerized tomography (3,4) or magnetic resonance images (4) or any other process from which information can be exported as voxel-based tomographic images. This is the limiting step in the precision of the model.…”

“…polymer (polyethylene terephthalate) as has been used for half a century in vascular grafts (4). This has now been done in over 100 patients.…”

“…The fundamental attraction of 3-D printing over the usual range of surgical illustrations is that it provides a 'graspable' object (2). The word 'graspable' which we have borrowed from Regnier, is particularly appropriate in this context in that it indicates a physical object which the surgeon can literally grasp, manipulate in the hands (3,4), and cut in operative rehearsals (5). Being able to manipulate the object while simultaneously viewing it may have a significant impact on the understanding of 3-D anatomy by the surgeon.…”

Surgical treatment of Marfan syndrome and related disorders is all about dealing with uncertainties

“…Although guidelines supply us with the threshold values of aortic root aneurysm size for elective surgical treatment in these conditions, they do not specify which surgical procedure should be performed 3. These surgical procedures have evolved from classical aortic root replacement, including valve replacement with a mechanical or biological valve (Bentall procedure) to valve sparing techniques (David and Yacoub procedures) and even external procedures (personalised external aortic root support (PEARS) procedure) performed off pump, where the aortic root is left in place and reinforced by a sleeve from the outside 4. Moreover, as the newer valve sparing procedures are sometimes considered less invasive or less influential on daily postsurgical life, they may influence timing of elective aortic (root) surgery, relatively independent of the aneurysm size thresholds mentioned in the guidelines.…”