ExoVasc® Personalised External Aortic Root Support (PEARS) - Question

[Guest]

Hi Everybody and big apology for not been a registered user in the forum, for some reason the system returns an error every time I try

As many before me I'm an owner of a BAV with a 5,3 cm Ascending Aorta aneurysm. My valve, although bicuspid is working fine and apart from the size on the aorta I'm feeling fine. As I live in the UK, our NHS (National Health Service) covers a relatively new treatment called Personalised External Aortic Root Support (PEARS).

http://www.exstent.com/exovasc.html

Basically, they don't replace the Aorta but built an scaffolder around it. To be honest, when you read about it it looks amazing, almost too amazing. No bypass machine during surgery, only 2 hours procedure, no anticoagulants. And, 100% success so far, except for one unrelated death 5 years after the procedure.

I'm in contact with them for a while and this is what I got back

• Left Ventricle normal size and function
• Mitral valve good function with trivial regurgitation
• Aortic valve good function
• Aortic root/ascending aorta mildly dilated

With your fitness and good aortic function I would suggest you are the perfect recipient of an ExoVasc: asymptomatic, mildly dilated, probably with good natural symmetry in the aortic valve sinuses.

Obviously lots of test need to be done to confirm if I can go for it, buy I'm curious, has anybody heard anything (good or bad) about it?

Big thank you!

Manuel

 

[themalteser]

Hello mate! Yep I was in touch (and still am) with Tal Golesworthy. Incredible guy. I also talked to professor pepper and made some research including discussing with my cardiologist.

The PEARS is definitely the way forward and outlook is great, 100% success as you said apart from the guy who lost his life due to a cardiac arrhythmia, but unrelated to PEARS.

When its it's time for me to have surgery, I will definitely opt for this surgery. I'm at 46/7mm at the moment.

The only perhaps drawback is that it's not been heavily tested in bicuspids, but rather in Marfans. There may be some differences. One of them being if valve needs replacement or re-replacement.

If if you're talking to Tal, you're in good hands. He is a great guy. Keep in touch.

 

[pearjas]

I remember reading about this, but it's not available in the US. It sounds great, but I'm wondering why the United States hasn't jumped on board yet?

 

[manuel_Scotland]

themalteser Agree, he is an amazing guy and very informative. Regarding the perhaps, I ask him exactly about it. What if I need a replacement in the future, the answer was:

The PEARS/ExoVasc implant becomes fully incorporated into the adventitia (outer layer of the aorta) but is made of polyester ( the suture thread of choice) so is no problem for scalpels and other surgical instruments. If you need an Aortic Valve repair/replacement at a subsequent date, the ExoVasc will not impede that surgery in any way.

To be honest, this method sounds too good to be true

 

[themalteser]

manuel_Scotland I think it's a no brainer. Stats are excellent and the procedure seems less risky than others. It's NHS funded and I think surgery is performed by Mr Austin.

I don't know where I read it, but professor treasure, now retired who was one of the first surgeons with professor pepper to perform this procedure, talked about some technique complications around the coronary arteries. Just to cover everything it may be worth asking Tal. I'll try and find the document or video. Im sure Tal will explain this fully.

Keep us posted. Are you planning to go ahead with this procedure?

 

[manuel_Scotland]

themalteser Agree with you, a total no brainer. I'm been considered for it at the moment. I have a CT scheduled in a few weeks that I hope should sort out any doubts. I asked Tal exactly your question and this is the answer

Surgery around the aortic root is difficult because the aorta is buried quite deeply inside the heart and coronary blood flow (that feeds blood to the heart muscle [myocardium]) has to be maintained. PEARS surgery is slightly easier than root replacement surgery, though both are complex.

I also asked about possible rupture of the Aorta inside the PEARS years after the "installation" and this was the answer:

The mechanical strength of the PEARS textile is such that your left ventrical would be incapable of providing a large enough pressure to burst your aorta inside the ExoVasc

I'll keep you all posted, but if I'm suitable, I'll go ahead and leave this in the past as an bad/interesting memory.

 

[Ultrarunner]

I can see how the ExoVasc procedure would prevent aortic rupture. But how would it help prevent dissection? If the material is incorporated into the outer layer of the aorta, what is to stop blood forming a channel between the synthetic outer layer and inner layer?

 

[valdab]

I am in a similar position to themalteser - have met with the delightful Prof Pepper a couple of times and also spoken with Tal Goldsworthy - also charming and extremely helpful. I am pretty sure that when my time comes, this is the way I will go