Type B aortic dissection following personalized external aortic root support (PEARS): a report of two cases

Area of Science:

• Cardiovascular Surgery
• Genetics
• Vascular Medicine

Background:

• Personalized external aortic root support (PEARS) is a prophylactic surgery for heritable thoracic aortic disease (HTAD).
• Early PEARS outcomes are promising, but distal aortic complications are not well understood.
• Type B aortic dissection (TBAD) after PEARS is rarely documented.

Purpose of the Study:

• To report and analyze cases of Type B aortic dissection (TBAD) occurring after Personalized External Aortic Root Support (PEARS) implantation in patients with heritable thoracic aortic disease (HTAD).

Main Methods:

• Case report detailing two patients with HTAD (Loeys-Dietz syndrome and Marfan syndrome) who developed complicated TBAD years after PEARS.
• Description of surgical interventions including frozen elephant trunk (FET) and descending thoracic aortic replacement.
• Long-term radiological surveillance.

Main Results:

• Two patients with HTAD developed complicated TBAD post-PEARS.
• One patient with Loeys-Dietz syndrome required emergency total arch replacement with FET and abdominal surgery for visceral malperfusion.
• One patient with Marfan syndrome underwent descending thoracic aortic replacement and later staged arch replacement with FET due to dissection extension.

Conclusions:

• Distal aortic dissection remains a risk even after PEARS in HTAD patients.
• These cases highlight the necessity of ongoing, comprehensive aortic imaging surveillance post-PEARS.
• While causality is not established, these findings underscore the importance of monitoring the entire aorta.