Journal Article

Personalised external aortic root support for elective treatment of aortic root dilation in 200 patients

Golesworthy, Tal, Rega, Filip, Verbrugghe, Peter, Austin, Conal, Treasure, Tom, Pepper, John R, Van Hoof, Lucas, Takkenberg, Johanna J M

2021

Overview

Background and objectivesIn personalised external aortic root support (PEARS), a custom-made, macroporous mesh is used to stabilise a dilated aortic root and prevent dissection, primarily in patients with genetically driven aortopathies. Data are needed on the safety and postoperative incidence of aortic events.MethodsWe present a multicentre cohort study evaluating the first 200 consecutive patients (median age 33 years) undergoing surgery with an intention to perform PEARS for aortic root dilatation in 23 centres between 2004 and 2019. Perioperative outcomes were collected prospectively while clinical follow-up was retrieved retrospectively. Median follow-up was 21.2 months.ResultsThe main indication was Marfan syndrome (73.5%) and the most frequent concomitant procedure was mitral valve repair (10%). An intervention for myocardial ischaemia or coronary injury was needed in 11 patients, 1 case resulting in perioperative death. No ascending aortic dissections were observed in 596 documented postoperative patient years. Late reoperation was performed in 3 patients for operator failure to achieve complete mesh coverage. Among patients with at least mild aortic regurgitation (AR) preoperatively, 68% had no or trivial AR at follow-up.ConclusionsThis study represents the clinical history of the first 200 patients to undergo PEARS. To date, aortic dissection has not been observed in the restrained part of the aorta, yet long-term follow-up is needed to confirm the potential of PEARS to prevent dissection. While operative mortality is low, the reported coronary complications reflect the learning curve of aortic root surgery in patients with connective tissue disease. PEARS may stabilise or reduce aortic regurgitation.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Aged / aneurysm / Aneurysm, Dissecting - diagnosis / Aneurysm, Dissecting - etiology / Aneurysm, Dissecting - prevention & control / Aneurysms / Aorta, Thoracic - diagnostic imaging / Aorta, Thoracic - surgery / Aortic and vascular disease / aortic aneurysm / Aortic Aneurysm, Thoracic - complications / Aortic Aneurysm, Thoracic - diagnosis / Aortic Aneurysm, Thoracic - surgery / Aortic aneurysms / Aortic dissection / Child / Child, Preschool / Coronary vessels / Data analysis / Data collection / Demographics / dissecting / Elective Surgical Procedures - methods / Female / Follow-Up Studies / Heart surgery / Heart Valve Prosthesis Implantation - methods / Hospitals / Humans / Magnetic Resonance Imaging, Cine / Male / Marfan syndrome / Middle Aged / Patients / Retrospective Studies / Surgical Mesh / Tomography, X-Ray Computed / Variables / Young Adult