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ExoVasc® Personalised External Aortic Root Support (PEARS) is a conservative treatment to manage aortic dilation and dissection in patients with Marfan syndrome.

The treatment was pioneered by Professor John Pepper through the creation of a device by Exstent Ltd. Today, over 60 patients have been successfully treated with the approach at Royal Brompton Hospital.

Showcase at Arab Health

This procedure was performed for the first time in the Middle East at the Arab Health conference 2016, by Mr Ulrich Rosendahl, to showcase the expertise of Royal Brompton & Harefield Hospitals Specialist Care. The simulation demonstrated a less invasive approach to conventional treatments for aortic dilation.

Elective root replacement in Marfan and other syndromes generally leads to improved life expectancy in affected patients. Detection, diagnosis, monitoring, and prophylactic surgery are believed to have dramatically reduced deaths from dissection and to have resulted in increased longevity in these patients. As a result, the threshold for intervention has reduced progressively.

Surgical options to suit different cases

Three forms of surgery are now available:

Total root replacement with a valved conduit can be performed irrespective of aortic dimensions. A valve replacement is a secure and near-certain means of correcting aortic valve regurgitation, but it has small thromboembolic and bleeding risks if a mechanical device is chosen. For this reason, root replacement with a biological conduit (Freestyle®) is the preferred approach at Royal Brompton Hospital.

Valve sparing root replacement (VSRR) offers freedom from anticoagulation and attendant risks of bleeding. However, every year 1.3 per cent of cases require a repeat operation. While this may seem a low figure, in a young Marfan patient this means that more than 25 per cent will require another operation on their aortic valve within 20 years.

Personalised external aortic root support (PEARS) uses a macroporous mesh sleeve which is manufactured and tailored to the patient’s own aortic dimensions. It includes the advantages of VSRR, while avoiding myocardial ischemia and usually cardiopulmonary bypass.

The PEARS technique

For the operation of PEARS, the dimensions of the individual patient's aorta are determined by digital images from a preoperative CT scan. These are then used to make a three-dimensional model of the patient's aorta in computer aided design (CAD).

A physical model is produced using 3D printing techniques. On this physical model, an external support of a medical grade polymer fabric mesh with 0.7 mm pore size is made.

Via open chest surgery, the ExoVasc™ support is placed around the ascending aorta. It provides support to the patient’s own aorta and aortic valve, and it is designed to prevent enlargement and rupture.

The procedure is performed by Mr Ulrich Rosendahl and it takes around two hours for the full surgery. Patients are normally discharged between five and seven days after their surgery.

This innovative procedure sets a new standard in the surgical management of the dilated aorta and its effectiveness is proven by a total of over 250 patient years’ experience gained during the past decade.


Consultants

Mr Ulrich Rosendahl 

Consultant cardiac surgeon

 

 

 

Professor John Pepper

Consultant cardiac surgeon