Melbourne Private Hospital shows its heart is in the right place after performing Australian first

3D printing and insight from a boiler engineer have led to heart specialists to complete an Australian first at Melbourne Private Hospital.

The country’s first Personalised External Aortic Root Support, or PEARS, procedure has been performed at Melbourne Private Hospital.

The procedure involves installing a custom sleeve, woven over a 3D printed aorta obtained from a CT scan, from the base of the patient’s aorta to the aortic arch, offering an external support to repair an aortic aneurysm. It can be performed while the heart is still beating, removing the need to use a heart-lung machine or cardiopulmonary bypass.

Cardiothoracic Surgeon, Professor Alistair Royse said the scale of the PEARS procedure was substantially less than the conventional operation, which normally involves replacing part of the ascending aorta or the aorta and aortic valve if both are damaged by an aneurysm.

“Whilst the operation is still quite a large operation and still requires opening the chest, the entire operation is performed “off pump” or without the use of cardiopulmonary bypass and overall takes approximately two hours to perform instead of the usual 4-6 hours,” Professor Royse said.

“The recovery is more rapid due to the scale of the surgery being smaller.

“Additionally, since there has been no change to the aorta itself or aortic valve, there is no need for any additional medications such as warfarin (a blood thinner), novel antiplatelet agents or even aspirin.”

Professor Royse said the patient who received Australia’s first PEARS procedure was recovering well.

“Although the patient was sent to the intensive care unit, as is the usual practice for cardiac surgery, future cases will likely be accompanied by a 4-6 day hospital stay, compared with the typical 9-12 days expected after conventional surgery.”

PEARS was first performed in the UK after Tal Golesworthy - a boiler engineer with Marfran’s Syndrome, a genetic disorder which can result in a stretching of the aorta – viewed the condition as essentially a “standard plumbing problem” and conceived a way to repair his own aorta using engineering principals.

Mr Golesworthy saw the aorta as a pipe and believed the aortic root aneurysm didn’t need to be replaced but could instead be supported externally like a bulging pipe. And this led to the development of PEARS.

Paul, the first Australian PEARS recipient and also an engineer, read an article about Mr Golesworthy while weighing up his options to repair his own aorta, which had dilated to the upper limit of 55mm.

“I thought, this could work for me. He’s an engineer and I’m an engineer, the planets are pushing me towards the (PEARS) surgery,” Paul said.

“(Conventional) bypass surgery to access the aorta didn’t strike me as something that I wanted to go through and nor did I want to be on lifelong anticoagulants”.

“Professor Royse had helped me weigh up the risks of surgery versus no surgery and I knew that there was limited chance of survival if my aorta was to rupture.”

Paul was in hospital for six days following the PEARS procedure which he believes is a great outcome.

Many years previously, the aorta had been wrapped in cellophane (plastic) sheeting. This was abandoned because whilst it seems to work in the area where the cellophane was placed, it did not address the aorta on either side of the sheeting. Albert Einstein had a cellophane wrap for an abdominal aortic aneurysm, and survived for about six years after its placement before he suffered a rupture.

PEARS seeks to address the shortcoming of the previous cellophane sheeting by covering the entire ascending aorta from its origin at the aortic valve, to the aortic arch.

Professor Royse said given the groundbreaking nature of PEARS, the procedure was still relatively limited, so reasonable caution about long-term outcomes needed to be considered. “However, there have been two significant publications¬1 in the past two years that would give reasonable confidence that this procedure is achieving its intended goals as well as being a durable solution,” Professor Royse said.

Melbourne Private General Manager Leanne Umstad said she was delighted the hospital performed an Australian first and now offered patients an alternative procedure to repair aortic aneurysms.

“At Melbourne Private, we work together for better care, and we are pleased we have been able to support Professor Royse and his team in delivering this new procedure,” Ms Umstad said.

1. Reference Publications:

Treasure T, Petrou M, Rosendahl U, Austin C, Rega F, Pirk J et al. Personalized external aortic root support: a review of the current status. Eur J Cardiothorac Surg 2016; 50:400-4.

Izgi C, Newsome S, Alpendurada F, Nyktari E, Boutsikou M, Pepper J, Treasure T, Mohiaddin R External Aortic Root Support to Prevent Aortic Dilatation in Patients With Marfan Syndrome. JAAC 2018: 72:1095-105