Innovative customised procedure can help to prevent aortic aneurysms

Straits Times

2 days ago

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Adjunct Associate Professor Vitaly A. Sorokin (left) and Adjunct Associate Professor Low Ting Ting with Mr Long Foo Pieng, who was among the first few patients to undergo the procedure.
SINGAPORE - Aortic aneurysms – where the aorta, the largest artery in the human body, swells to more than 1½ times its normal size – is estimated to result in up to 200,000 deaths worldwide annually.
In cases of aortic rupture, when all the layers of the aorta wall tear, there is an 80 per cent mortality rate.
An innovative surgical procedure , now available in Singapore, can stop an aneurysm from growing and prevent an aortic rupture from happening.
Originating from the heart's left ventricle, the aorta is the body's main artery, directing oxygenated blood from the heart to the rest of the body.
An aortic aneurysm can be caused by many factors, such as high blood pressure, genetic conditions or aortic valve issues.
The condition is often under-diagnosed, thus increasing the risk that the bulge in the aorta continues to grow and eventually ruptures along the elastic wall, resulting in rapid, life-threatening blood loss.
To reduce the risk of such an occurrence, the National University Heart Centre, Singapore (NUHCS) has introduced a procedure called the Personalised External Aortic Root Support (Pears), which uses a custom-made, open mesh support sleeve to reinforce a weakened aorta.
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When applied at the earlier stages of an aneurysm before the aorta has grown too large, Pears acts as a protective 'glove' around the artery, preventing further expansion and significantly reducing the risk of a rupture.
'The open-mesh sleeve used to support the weakened aorta in Pears is custom-shaped to a 3D-printed model of a patient's aorta from their CT scan,' said Adjunct Associate Professor Vitaly A. Sorokin, who heads the adult cardiac surgery division at NUHCS' cardiac, thoracic and vascular surgery department.
'Due to the customised nature of this sleeve, it provides personalised long-term structural support to the heart vessel, which is crucial in stopping the aneurysm from growing larger,' he added.
Pears is developed by British medical manufacturing firm Exstent, whose founder, Mr Tal Golesworthy, has Marfan syndrome – a genetic disorder that affects the body's connective tissue and can weaken the aorta's walls.
An engineer by training, Mr Golesworthy designed Pears as a solution to treat his own aorta, becoming the first person to have the device implanted in 2004.
Though the procedure has been around for more than two decades, it has only become more widely adopted internationally over the past 10 years, amid advancements in CT scanning and 3D printing, said Prof Vitaly.
NUHCS is believed to be the first centre to introduce Pears in South-east Asia, first performing the procedure in November 2024.
Six patients, aged between 40 and 55, have undergone the procedure since it was introduced, all of whom are faring well.
Among the first few patients to undergo the procedure was 56-year-old Long Foo Pieng, who in 2004 was diagnosed with congenital bicuspid aortic valve – a heart defect present at birth, where the aortic valve has only two leaflets instead of three.
This can result in aortic stenosis, where the valve narrows, or aortic regurgitation, where the blood flows backwards from the aorta into the left ventricle. These conditions can be fatal if severe and left untreated.
The retired company director initially managed the condition using medication and lifestyle adjustments, as surgery would require that the valve be replaced with a prosthetic substitute, which would require significant changes to his lifestyle, said Adjunct Associate Professor Low Ting Ting, a senior consultant with the cardiology department.
However, his condition eventually led to aortic dilation, requiring surgery.
'When this Pears procedure came along, it allows us to manage to constrict the size of his aorta without replacing the aortic valve,' said Prof Low.
After undergoing Pears, Mr Long was discharged from the hospital within a week.
He recovered well and in six months was able to resume his normal day-to-day activities.
'I was very happy back at the golf course again, going to the driving range almost two to three times a week,' he said.