Personalized External Aortic Root Support (PEARS) in the Treatment of Marfan Syndrome and Bicuspid Aortic Valve Aneurysms: First Case Series in the American Continent

Introduction:  Conventional surgical approaches for aortic root aneurysms, including valved grafts and valve-sparing techniques, present inherent limitations such as the requirement for anticoagulation and the potential for late reoperation. Personalized External Aortic Root Support (PEARS), utilizing the ExoVasc® implant, represents a novel approach that aims to overcome these limitations.

Methods:  This report presents the initial clinical experience with the ExoVasc® PEARS implant in the Americas, encompassing 10 patients (six males, age range 30 - 52 years, mean age 37.8 years) diagnosed with aortic root aneurysms. Indications for PEARS included Marfan syndrome (eight patients, including one reoperation), bicuspid aortic valve (two patients, including one with anomalous coronary artery), and associated valvular dysfunction. Cardiopulmonary bypass was utilized in four cases.

Results:  No major adverse postoperative events were observed. Postoperative recovery was generally uneventful, with minor complications, including pericarditis and atrial fibrillation, successfully managed with medical therapy. Aortic dimensions remained stable at 30-day and one-year follow-ups.

Conclusion:  This initial experience demonstrates the feasibility, safety, and efficacy of the PEARS technique for the treatment of aortic root aneurysms. Potential advantages over traditional approaches include the possibility for off-pump procedures, reduced risk of aortic valve dysfunction, shorter hospital stays, and elimination of the need for long-term anticoagulation therapy. Further investigation is warranted to evaluate the long-term durability and clinical outcomes of this innovative approach.

Keywords:
Marfan Syndrome; Aortic Root Aneurysm; Cardiopulmonary Bypass; Pyrus; Atrial Fibrillation; Coronary Vessels; Anticoagulants; Pericarditis.