The personalized external aortic root support procedure: interesting niche or ready for prime time?

Aortic root dilation is nearly universal among patients with Marfan syndrome (MFS) and many patients require aortic root replacement to prevent devastating aortic catastrophe. This has traditionally entailed placement of a composite-valved graft, often with a mechanical aortic valve, necessitating lifelong anticoagulation. In the 1990s, a significant development within the field of cardiac surgery occurred, and valve sparing root replacement (VSRR) techniques were developed and refined. These allow prophylactic replacement of aortic root aneurysms while sparing a healthy, functioning aortic valve. These techniques have been shown to be safe and durable in patients with MFS.1 2 However, VSRR is a technically demanding procedure that is not available in all cardiac centres. This has led some to investigate alternatives to VSRR, in an effort to make these repairs both safer and more generalisable within the cardiac surgical community. Van Hoof and colleagues3 report outcomes on the first 200 consecutive patients undergoing the personalized external aortic root support (PEARS) procedure. The results of this innovative procedure are very encouraging, with a 0.5% perioperative mortality. Late reoperations were only performed in three patients, and no type A dissections occurred during the follow-up period. Further, the PEARS procedure seems to have a positive impact on aortic regurgitation and medium-term valve outcomes seem promising. These results are remarkable and the authors and surgeons dedicated to pioneering this innovative approach …