The authors report the first Dutch experience with Personalized External Aortic Root Support (PEARS) in patients at risk of aortic dissection due to connective tissue disorders or bicuspid aortic valve. Between 2018 and 2023, 90 patients underwent surgery in Amsterdam and Leiden. Most were young adults, often with Marfan syndrome, Loeys-Dietz syndrome, or bicuspid valves. PEARS involves placing a tailor-made polyester mesh around the aortic root to prevent further enlargement while preserving the native valve. In this cohort, two-thirds had isolated PEARS, while others received it with a Ross procedure or other cardiac surgery. Short-term results were encouraging. Procedural success was high, aortic dimensions stabilized, and no deaths or dissections occurred during follow-up. A few patients required reoperation, mainly due to coronary artery issues. The authors conclude that PEARS appears safe and effective in the short term but emphasize the need for longer follow-up and larger studies.