Professor of Cardiothoracic Surgery, University College London, London WC1E 6BT UK.
Consultant Cardiac Surgeon, St Thomas' Hospital, London SE1 7EH, UK.
Curr Opin Cardiol. 2022 Nov 1;37(6):454-458. doi: 10.1097/HCO.0000000000000990. Epub 2022 Aug 26.
To bring together and annotate publications about personalised external aortic root support reported in the 18 months preceding submission.
The total number of personalised external aortic root support (PEARS) operations is now approaching 700 in 30 centres in Australia, Belgium, Brazil, Czech Republic, Great Britain, Greece, Ireland, Malaysia, Netherlands, New Zealand, Poland and Slovakia. There are continued reports of stability of aortic dimensions and aortic valve function with the only exceptions known being where the surgeon has deviated from the instructions for use of the device. The median root diameter of Marfan patients having PEARS was 47 mm suggesting that the existing criterion of 50 mm is due for reconsideration. The peri-operative mortality currently estimated to be less than 0.3%. The first recipient remains alive and well after 18 years. The use of PEARS as an adjunct to the Ross operation to support the pulmonary autograft is being explored in several centres.
The operation requires proctoring and adherence to a strict operative protocol and with those precautions excellent results are attained. The evidence and opinions provided in the cited publications indicate that PEARS is a proven and successful prophylactic operation for aortic root aneurysm.
汇集并注释在提交前的 18 个月内发表的关于个性化外部主动脉根部支撑的文献。
目前在澳大利亚、比利时、巴西、捷克共和国、英国、希腊、爱尔兰、马来西亚、荷兰、新西兰、波兰和斯洛伐克的 30 个中心，个性化外部主动脉根部支撑（PEARS）手术的总数已接近 700 例。有持续的报告表明主动脉尺寸和主动脉瓣功能稳定，已知的唯一例外是外科医生偏离了器械使用说明。接受 PEARS 手术的马凡综合征患者的主动脉根部直径中位数为 47mm，表明现有的 50mm 标准需要重新考虑。目前估计围手术期死亡率低于 0.3%。首例接受者在 18 年后仍然存活且状况良好。一些中心正在探索将 PEARS 作为 Ross 手术的辅助手段，用于支撑肺动脉自体移植物。
该手术需要指导和严格遵守手术协议，只要采取这些预防措施，就可以获得出色的效果。所引用文献中的证据和观点表明，PEARS 是一种经过验证和成功的预防主动脉根部瘤的手术。
