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International Society For Minimally Invasive Cardiothoracic Surgery

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Personalised External Aortic Root Support: Impact On Aortic Root Dimensions And Aortic Incompetence Post Procedure
Samara Fleville, Katie E. O'Sullivan, Andrew McReynolds, Peter Ball, Alastair Graham.
Royal Victoria Hospital Belfast, Belfast, United Kingdom.

Background Downsizing of aortic dimensions by PEARS procedure may ameliorate aortic incompetence (AI) associated with aneurysms of the aortic root. The precise geometric characteristics of this have not yet been studied. Methods We performed a retrospective study assessing all PEARS procedures undertaken in our institution between November 2016 and August 2019. Results Twelve patients underwent PEARS, two having concomitant mitral valve repair (9 males; 3 females; median age: 37 years). Five patients had AI ranging from trivial to moderate pre procedure with all showing a reduction of AI post PEARS. Eight patients had comparative post-operative imaging; 5 had a 100% graft and 3 had a 95% graft implanted. For the 100% graft, there was a reduction of the Sinus of Valsalva diameter (mean: 4.2mm; p-value = 0.03). Use of the 95% graft resulted in a reduction of the ascending aorta diameter (mean: 4.33mm; p= 0.02) (Figure 1). There was significant variability between predicted and actual post-operative measurements. Discussion We demonstrate that the PEARS graft significantly downsizes the ascending aortic and root dimensions but does so in a variable manner. Aortic incompetence was improved in all cases. The implications of this for graft sizing and planned downsizing require further investigation.


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