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The Exostent Versus Alternative Strategies: The Role of an External Support Sleeve in Aortic Prophylaxis

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Controversies in Aortic Dissection and Aneurysmal Disease

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Abstract

Aneurysms of the thoracic aorta often have a strong genetic link in their aetiology. The commonest example of this is the Marfan Syndrome. Fatal aortic dissection occurs at a young age in this disease. Prevention relies on elective replacement of the aortic root. The placement of an external root support, tailored to the anatomy of the individual patient has been proposed as a feasible alternative. We have offered this procedure to patients with Marfan syndrome whose aortic root diameter lies between 40 and 55 mm and without aortic regurgitation. By computer-aided design, a model of the individual patient’s aorta was created from cardiac magnetic resonance images and a bespoke external aortic support was manufactured. Comparative measurements were made of the ascending aorta at the level of closure of the aortic valve leaflets from magnetic resonance imaging studies.

Thirty three patients have been operated upon from May 2004 to July 2012, 23 men and 10 women, median age 33 years. All patients are alive and well at the time of last follow-up. Preoperative aortic root diameters were 40–50 mm. All postoperative images were satisfactory with an overall reduction in aortic root dimensions. The operation took half the time of other aortic root surgery, cardiopulmonary bypass was used only in the first patient for 20 min, myocardial ischaemia was not required in any patient, and no post-operative anticoagulation is mandated.

The primary objective of the surgery was achieved, reinforcing the ascending aorta while leaving the native aortic valve intact and conserving the blood/endothelium interface.

On Behalf Of The Exostent Group Of Surgeons: Mario Petrou, Oxford University Hospitals Nhs Trust, Oxford, United Kingdom; Filip Riga, Department Of Cardiac Surgery, University Of Leuven, Leuven, Belgium; Ulrich Rosendhal, Royal Brompton Hospital, London, United Kingdom; And Tom Treasure, CORU, UCL, London, United Kingdom

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Acknowledgement

This work was supported by the NIHR Cardiovascular Biomedical research unit at the Royal Brompton Hospital.

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Authors and Affiliations

  1. Clinical Evaluation Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    John R. Pepper MA, MChir, FRCS, FESC

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  1. John R. Pepper MA, MChir, FRCS, FESC
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Correspondence to John R. Pepper MA, MChir, FRCS, FESC .

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Editors and Affiliations

  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Pepper, J.R. (2014). The Exostent Versus Alternative Strategies: The Role of an External Support Sleeve in Aortic Prophylaxis. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_5

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  • DOI: https://doi.org/10.1007/978-1-4471-5622-2_5

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  • Online ISBN: 978-1-4471-5622-2

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