View source for Archive:Personalised external aortic root support

{{Short description|Medical procedure for aortic root aneurysms}}
{{Use dmy dates|date=July 2025}}

The '''Personalised External Aortic Root Support''' (PEARS) is a medical procedure designed to manage [[aortic root]] aneurysms, particularly in patients with connective tissue disorders such as [[Marfan syndrome]]. This technique involves the use of a bespoke microporous textile mesh jacket, tailored precisely to the dimensions of an individual's aorta, providing an alternative to conventional surgical methods.<ref name="Operative Techniques">{{cite journal |author1=Golesworthy T. |author2=Treasure T. |title=Personalized External Aortic Root Support (PEARS) for Aortic Root Aneurysm |journal=Operative Techniques in Thoracic and Cardiovascular Surgery |year=2021 |doi=10.1053/j.optechstcs.2021.03.001}}</ref>

==Medical uses==

PEARS is used to support the aortic root and the ascending aorta in patients with aortic root aneurysms. It is particularly beneficial for patients with connective tissue disorders such as Marfan syndrome, [[Loeys-Dietz syndrome]], or those with a [[bicuspid aortic valve]]. The procedure helps to prevent aortic root expansion and aortic dissection, which can lead to severe complications such as aortic valve regurgitation, rupture, and death.<ref name="BJC">{{cite journal |author1=Golesworthy T. |title=Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm |journal=The British Journal of Cardiology |year=2020 |url=https://bjcardio.co.uk/2020/07/personalised-external-aortic-root-support-pears-to-stabilise-an-aortic-root-aneurysm/}}</ref><ref name="NICE">{{cite web |title=Personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome |url=https://www.nice.org.uk/guidance/ipg724 |publisher=NICE |year=2021}}</ref>

==Procedure==

The PEARS procedure begins with a detailed [[CT scan]] of the patient's aorta to gather precise measurements. These measurements are then used with [[computer-aided design]] (CAD) technology to create a 3D-printed plastic model of the patient's aorta. This model serves as a template for manufacturing the ExoVasc PEARS implant, which is made from a soft and pliable biocompatible textile, typically [[polyethylene terephthalate]].

The implantation process involves opening the chest through the breastbone and wrapping the mesh around the outside of the aorta at the part closest to the heart. This mesh provides graduated support to the aortic root and ascending aorta, reducing the risk of aortic root expansion and aortic dissection.<ref name="ScienceDirect">{{cite journal |author1=Treasure T. |author2=Austin C. |author3=Kenny LA |author4=Pepper J. |title=Personalized External Aortic Root Support (PEARS) for Aortic Root Aneurysm |journal=Operative Techniques in Thoracic and Cardiovascular Surgery |year=2021 |doi=10.1053/j.optechstcs.2021.03.001}}</ref><ref name="Exstent">{{cite web |title=ExoVasc® Personalised External Aortic Root Support |url=https://exstent.com/exovasc-personalised-external-aortic-root-support/ |publisher=Exstent |year=2024}}</ref>

===Aortic PEARS===

In the Aortic PEARS procedure, the ExoVasc PEARS supports the dilated aorta in patients with connective tissue disorders. This procedure is less invasive compared to traditional surgical options and does not require [[cardiopulmonary bypass]].<ref name="PubMed">{{cite journal |author1=Treasure T. |author2=Austin C. |author3=Kenny LA |author4=Pepper J. |title=Personalized external aortic root support: a review of the current status |journal=PubMed |year=2022 |doi=10.1097/HCO.0000000000000990}}</ref>

===Ross-PEARS===

The Ross-PEARS procedure involves replacing a diseased aortic valve with the patient's own healthy pulmonary valve, which is then supported by an ExoVasc PEARS. This procedure is particularly useful for patients who require aortic valve replacement but wish to avoid mechanical valve replacement and the associated need for anticoagulation.<ref name="NCBI">{{cite journal |author1=Golesworthy T. |title=Personalized External Aortic Root Support - PMC |journal=NCBI |year=2013 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853825/}}</ref>

==Advantages==

One of the significant advantages of the PEARS procedure is that it does not require cardiopulmonary bypass, although it has been used occasionally as an adjunct. The aorta is not clamped or opened, so there is no myocardial ischemia involved. Additionally, there is no routine requirement for blood products, nor is there a risk of cerebral ischemia or embolus. This makes the procedure less invasive and reduces the recovery time for patients.<ref name="NCBI2">{{cite journal |author1=Golesworthy T. |title=Personalised External Aortic Root Support (PEARS) Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root |journal=NCBI |year=2017 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548228/}}</ref>

Clinical outcomes for PEARS have been favorable. In over 200 patient-years of follow-up, there have been no untoward events related to the aortic wall or valve after PEARS. When compared with data for either the Bentall procedure or valve-sparing root replacement, outcomes so far are very favorable for external support.<ref name="PMC">{{cite journal |author1=Treasure T. |author2=Austin C. |author3=Kenny LA |author4=Pepper J. |title=Personalised External Aortic Root Support (PEARS) Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root |journal=PMC |year=2017 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548228/}}</ref>

==History==

The concept of PEARS was first proposed in 2000 by Tal Golesworthy, an engineer with familial Marfan syndrome and an aortic root aneurysm. Golesworthy, driven by the need for a less invasive treatment option, assembled a research and development team to bring his idea to fruition. Collaborating with surgeons, the first clinical implementation of PEARS occurred in 2004, with Golesworthy himself being the first patient to undergo the procedure.<ref name="NCBI3">{{cite journal |author1=Golesworthy T. |title=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 |journal=NCBI |year=2017 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548228/}}</ref>

Since its inception, the PEARS procedure has been performed in several hospitals across England and Belgium, demonstrating its potential as a viable treatment option. The procedure has undergone health technology appraisal by the National Institute for Health and Care Excellence (NICE), further validating its efficacy and safety.<ref name="NICE2">{{cite web |title=Personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome |url=https://www.nice.org.uk/guidance/ipg724 |publisher=NICE |year=2021}}</ref>

==See also==

* [[Aortic aneurysm]]
* [[Marfan syndrome]]
* [[Connective tissue]]
* [[Cardiopulmonary bypass]]

==References==

{{Reflist}}

==External links==

* [ExoVasc® Personalised External Aortic Root Support](https://exstent.com/exovasc-personalised-external-aortic-root-support/)
* [Personalized External Aortic Root Support (PEARS) for Aortic Root Aneurysm - ScienceDirect](https://www.sciencedirect.com/science/article/pii/S1522294221000350)
* [Personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome - NICE](https://www.nice.org.uk/guidance/ipg724)
* [Personalised External Aortic Root Support (PEARS) Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548228/)
* [Personalized External Aortic Root Support - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853825/)
* [Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm - PubMed](https://pubmed.ncbi.nlm.nih.gov/27032474/)
* [Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm - The British Journal of Cardiology](https://bjcardio.co.uk/2020/07/personalised-external-aortic-root-support-pears-to-stabilise-an-aortic-root-aneurysm/)
* [Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4 - PubMed](https://pubmed.ncbi.nlm.nih.gov/27393865/)

[[Category:Medical procedures]]