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The '''personalised external aortic root support''' ('''PEARS''') is a medical procedure for [[aortic root]] aneurysms, can be in patients with connective tissue disorders such as [[Marfan syndrome]]. This technique uses a bespoke microporous textile mesh jacket, tailored precisely to the dimensions of a persons aorta, providing an alternative to conventional surgical methods.<ref name="Kenny Austin Conal Personalized External">{{cite journal |last1=Kenny |first1=Louise A. |last2=Austin |first2=Conal |last3=Golesworthy |first3=Tal |last4=Venugopal |first4=Prem |last5=Alphonso |first5=Nelson |title=Personalized External Aortic Root Support (PEARS) for Aortic Root Aneurysm |journal=Operative Techniques in Thoracic and Cardiovascular Surgery |date=Summer 2021 |volume=26 |issue=2 |pages=290–305 |doi=10.1053/j.optechstcvs.2021.03.001 |doi-access=free }}</ref> | |||
==Medical uses== | ==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 | PEARS is used to support the aortic root and also for the ascending aorta in patients with aortic root aneurysms. It is particularly beneficial for people that have connective tissue disorders like Marfan syndrome, [[Loeys–Dietz syndrome]], or [[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 |last1=Pepper |first1=J. |last2=Izgi |first2=C. |last3=Golesworthy |first3=T. J. |last4=Takkenberg |first4=J. J. |last5=Treasure |first5=T. |title=Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm |journal=British Journal of Cardiology |date=2020 |volume=27 |issue=3 |page=22 |doi=10.5837/bjc.2020.022 |pmid=35747770 |pmc=9205243 }}</ref><ref name="NICE">{{cite report |title=Personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome |publisher=[[National Institute for Health and Care Excellence]] |date=18 May 2022 |ID=IPG724 |url=https://www.nice.org.uk/guidance/ipg724 }}</ref> | ||
==Procedure== | ==Procedure== | ||
The PEARS procedure | The PEARS procedure relies on a detailed [[CT scan]] of the patient's aorta. These measurements are then used with [[computer-aided design]] to create a 3D-printed plastic model of the patient's aorta. This model serves as a template for manufacturing the ExoVasc PEARS implant. This implant is made from a soft and pliable biocompatible textile, normally [[polyethylene terephthalate]].{{fact|date=July 2025}} | ||
The | The surgical 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 support to the aortic root and ascending aorta, reducing the risk of aortic root expansion and aortic dissection.<ref name="Kenny Austin Conal Personalized External"/><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=== | ===Aortic PEARS=== | ||
The PEARS procedur supports the dilated aorta in patients with connective tissue disorders. This pocedure is less invasive than traditional surgical options and does not require [[cardiopulmonary bypass]].<ref>{{cite journal |last1=Treasure |first1=Tom |last2=Austin |first2=Conal |last3=Kenny |first3=Louise Amelia |last4=Pepper |first4=John |title=Personalized external aortic root support in aneurysm disease |journal=Current Opinion in Cardiology |date=29 August 2022 |volume=37 |issue=6 |pages=454–458 |doi=10.1097/HCO.0000000000000990 |pmid=36094493 |url=https://discovery.ucl.ac.uk/id/eprint/10155983/ }}</ref> | |||
===Ross-PEARS=== | ===Ross-PEARS=== | ||
The Ross-PEARS procedure involves replacing a diseased aortic valve with the patient's own healthy pulmonary valve, | The Ross-PEARS procedure involves replacing a diseased aortic valve with the patient's own healthy pulmonary valve, and then supporting the aorta via an implant. This procedure is particularly useful for patients who require [[aortic valve replacement]] but wsh to avoid mechanical valve replacement and the associated need for anticoagulation.<ref>{{cite journal |last1=Treasure |first1=Tom |title=Personalized external aortic root support |journal=Texas Heart Institute Journal |date=2013 |volume=40 |issue=5 |pages=549–552 |pmid=24391317 |pmc=3853825 }}</ref> | ||
==Advantages== | ==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 | 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. Additionlly, 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="Treasure Pepper Personalised External">{{cite journal |last1=Treasure |first1=Tom |last2=Pepper |first2=John |title=Personalised External Aortic Root Support (PEARS) Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root |journal=Diseases |date=15 January 2015 |volume=3 |issue=1 |pages=2–14 |doi=10.3390/diseases3010002 |doi-access=free |pmid=28943604 |pmc=5548228 }}</ref> | ||
==History== | ==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 | 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>{{cite journal |last1=Treasure |first1=Tom |last2=Takkenberg |first2=Johanna J M |last3=Golesworthy |first3=Tal |last4=Rega |first4=Filip |last5=Petrou |first5=Mario |last6=Rosendahl |first6=Ulrich |last7=Mohiaddin |first7=Raad |last8=Rubens |first8=Michael |last9=Thornton |first9=Warren |last10=Lees |first10=Belinda |last11=Pepper |first11=John |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=Heart |date=15 June 2014 |volume=100 |issue=12 |pages=969–975 |id={{CORE output|43293156}} {{ProQuest|1780732212}} |doi=10.1136/heartjnl-2013-304913 |pmid=24395977 |pmc=4033204 }}</ref> | ||
Since its inception, the PEARS procedure has been performed in | Since its inception, the PEARS procedure has been performed in hospitals, 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).<ref name="NICE"/> | ||
==See also== | ==See also== | ||
* [[Aortic aneurysm]] | * [[Aortic aneurysm]] | ||
* [[Marfan syndrome]] | * [[Marfan syndrome]] | ||
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==References== | ==References== | ||
{{Reflist}} | {{Reflist}} | ||
== | ==Further reading== | ||
* {{cite journal |last1=Treasure |first1=Tom |last2=Petrou |first2=Mario |last3=Rosendahl |first3=Ulrich |last4=Austin |first4=Conal |last5=Rega |first5=Filip |last6=Pirk |first6=Jan |last7=Pepper |first7=John |title=Personalized external aortic root support: a review of the current status |journal=European Journal of Cardio-Thoracic Surgery |date=September 2016 |volume=50 |issue=3 |pages=400–404 |doi=10.1093/ejcts/ezw078 |pmid=27032474 }} | |||
* | * {{cite journal |last1=Austin |first1=C. |last2=Mathur |first2=S.K. |last3=Pepper |first3=J. |title=Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4 |journal=International Journal of Cardiology |date=October 2016 |volume=220 |pages=772–774 |doi=10.1016/j.ijcard.2016.06.248 |pmid=27393865 }} | ||
* | |||
[[Category: | [[Category:Cardiac surgery]] | ||
Latest revision as of 18:48, 29 September 2026
The personalised external aortic root support (PEARS) is a medical procedure for aortic root aneurysms, can be in patients with connective tissue disorders such as Marfan syndrome. This technique uses a bespoke microporous textile mesh jacket, tailored precisely to the dimensions of a persons aorta, providing an alternative to conventional surgical methods.[1]
Medical uses
PEARS is used to support the aortic root and also for the ascending aorta in patients with aortic root aneurysms. It is particularly beneficial for people that have connective tissue disorders like Marfan syndrome, Loeys–Dietz syndrome, or 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.[2][3]
Procedure
The PEARS procedure relies on a detailed CT scan of the patient's aorta. These measurements are then used with computer-aided design to create a 3D-printed plastic model of the patient's aorta. This model serves as a template for manufacturing the ExoVasc PEARS implant. This implant is made from a soft and pliable biocompatible textile, normally polyethylene terephthalate.[citation needed]
The surgical 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 support to the aortic root and ascending aorta, reducing the risk of aortic root expansion and aortic dissection.[1][4]
Aortic PEARS
The PEARS procedur supports the dilated aorta in patients with connective tissue disorders. This pocedure is less invasive than traditional surgical options and does not require cardiopulmonary bypass.[5]
Ross-PEARS
The Ross-PEARS procedure involves replacing a diseased aortic valve with the patient's own healthy pulmonary valve, and then supporting the aorta via an implant. This procedure is particularly useful for patients who require aortic valve replacement but wsh to avoid mechanical valve replacement and the associated need for anticoagulation.[6]
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. Additionlly, 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.[7]
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.[8]
Since its inception, the PEARS procedure has been performed in hospitals, 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).[3]
See also
References
- ↑ 1.0 1.1 Kenny, Louise A.; Austin, Conal; Golesworthy, Tal; Venugopal, Prem; Alphonso, Nelson (Summer 2021). "Personalized External Aortic Root Support (PEARS) for Aortic Root Aneurysm". Operative Techniques in Thoracic and Cardiovascular Surgery 26 (2): 290–305. doi:.
- ↑ Pepper, J.; Izgi, C.; Golesworthy, T. J.; Takkenberg, J. J.; Treasure, T. (2020). "Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm". British Journal of Cardiology 27 (3): 22. doi:. PMID 35747770.
- ↑ 3.0 3.1 Template:Cite report
- ↑ "ExoVasc® Personalised External Aortic Root Support". Exstent. 2024. https://exstent.com/exovasc-personalised-external-aortic-root-support/.
- ↑ Treasure, Tom; Austin, Conal; Kenny, Louise Amelia; Pepper, John (29 August 2022). "Personalized external aortic root support in aneurysm disease". Current Opinion in Cardiology 37 (6): 454–458. doi:. PMID 36094493. https://discovery.ucl.ac.uk/id/eprint/10155983/.
- ↑ Treasure, Tom (2013). "Personalized external aortic root support". Texas Heart Institute Journal 40 (5): 549–552. PMID 24391317.
- ↑ Treasure, Tom; Pepper, John (15 January 2015). "Personalised External Aortic Root Support (PEARS) Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root". Diseases 3 (1): 2–14. doi:. PMID 28943604.
- ↑ Treasure, Tom; Takkenberg, Johanna J M; Golesworthy, Tal; Rega, Filip; Petrou, Mario; Rosendahl, Ulrich; Mohiaddin, Raad; Rubens, Michael; et al. (15 June 2014). "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". Heart 100 (12): 969–975. doi:. Template:CORE output Template:ProQuest. PMID 24395977.
Further reading
- Treasure, Tom; Petrou, Mario; Rosendahl, Ulrich; Austin, Conal; Rega, Filip; Pirk, Jan; Pepper, John (September 2016). "Personalized external aortic root support: a review of the current status". European Journal of Cardio-Thoracic Surgery 50 (3): 400–404. doi:. PMID 27032474.
- Austin, C.; Mathur, S.K.; Pepper, J. (October 2016). "Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4". International Journal of Cardiology 220: 772–774. doi:. PMID 27393865.