Author + information
- Received February 14, 2018
- Revision received June 14, 2018
- Accepted June 19, 2018
- Published online August 27, 2018.
- Cemil Izgi, MDa,
- Simon Newsome, MScb,
- Francisco Alpendurada, PhDa,c,
- Eva Nyktari, MDa,
- Maria Boutsikou, PhDa,
- John Pepper, MDc,
- Tom Treasure, MDd and
- Raad Mohiaddin, PhDa,c,∗ (, )@IzgiCemil@UCL@LSHTM@RBandH
- aCardiovascular Research Center & Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
- bDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- cNational Heart & Lung Institute, Imperial College, London, United Kingdom
- dClinical Operational Research Unit, University College London, London, United Kingdom
- ↵∗Address for correspondence:
Prof. Raad Mohiaddin, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, United Kingdom.
Background Personalized external aortic root support (PEARS) was introduced in 2004 for prevention of aortic root dilatation in Marfan patients. The individual's aortic root is replicated by 3-dimensional printing. A polymer mesh sleeve is manufactured, which is implanted with the aim to support and stabilize the aortic wall.
Objectives The aim of this study was to assess effectiveness of PEARS for prevention of aortic root dilatation in Marfan patients.
Methods A total of 24 consecutive Marfan patients operated 2004 to 2012 were prospectively monitored with magnetic resonance imaging. Following a pre-defined protocol, baseline and follow-up aorta measurements were made in a blinded random sequence.
Results The mean age of the patients was 33 ± 13.3 years (range: 16 to 58 years), and the mean aortic root diameter was 45 ± 2.8 mm (range: 41 to 52 mm). Follow-up was 6.3 ± 2.6 years. There was no increase in the aortic root and ascending aorta diameters, but there was a tendency toward reduction: annulus diameter 28.9 ± 2.3 mm to 28.5 ± 2.4 mm (change −0.39 mm, 95% confidence interval [CI]: −1.05 to 0.27 mm), sinus of Valsalva diameter 44.9 ± 2.9 mm to 44.5 ± 3.0 mm (change −0.37 mm, 95% CI: −1.23 to 0.51 mm), and ascending aorta diameter 32.4 ± 3.6 mm to 32.3 ± 3.7 mm (change −0.10 mm, 95% CI: −0.92 to 0.74 mm). In the same period, the descending aorta diameter increased from 22.9 ± 2.4 mm to 24.2 ± 3.0 mm (change 1.32 mm, 95% CI: 0.70 to 1.94 mm; p < 0.001) with a tendency toward increase in aortic arch diameter 24.1 ± 2.0 mm to 24.5 ± 2.8 mm (change 0.41 mm, 95% CI: −0.56 to 1.37 mm).
Conclusions PEARS is effective in stabilizing the aortic root and preventing its dilatation. It is a viable alternative for prevention of aortic root dissection in Marfan patients.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 14, 2018.
- Revision received June 14, 2018.
- Accepted June 19, 2018.
- 2018 American College of Cardiology Foundation
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