A New Alternative to Root Replacement in Marfan’s Syndrome: The ExoVasc Personalised Aortic Root Support

Thanks for the posting. The external supporting concept and the procedure seem quite similar to the "Florida sleeve" which has been advocated from the University of Florida for a decade. (Hess PJ, et al. Ann Thorac Surg 2005;80:748-50.)

We appreciate the comment. The external support method we describe, like the Florida sleeve was published a decade ago. (Golesworthy et al. Lancet 2004;364:1582) In that the Florida sleeve is an external support and allows conservation of the aortic valve, we agree that there are similarities. However there are also several important differences: • The mesh sleeve in Personalized External Aortic Root Support (PEARS) is computer modeled from the patient’s own digital images and is therefore ‘bespoke’ rather than ‘off the shelf’. • It extends the full length of the ascending aorta from the left ventricle to beyond the brachiocephalic artery. • It maintains exactly the configuration of the native sinuses and thus the architecture of the aortic valve support. (Treasure T, et al. N Engl J Med 2015;372:979-980.) • Its macroporous mesh structure results in it becoming fully incorporated with collagen in the aortic adventitia. (Cohen O, et al. Ann Thorac Surg 2007;83:S780-S784; Verbrugghe P, et al. Interact Cardiovasc Thorac Surg 2013;17:334-339.) • Restoration of normal histology within the mesh has been seen at autopsy and there is a plausible mechanism for this recovery. (Pepper J, et al. Eur J Cardiothorac Surg 2014.) Full technical details are provided on MMCTS Pepper J, et al. http://mmcts.oxfordjournals.org/content/2013/mmt004.full.pdf+html