P.E.A.R.S. now being performed in Brisbane, Australia (Prince Charles Hospital)

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Gordo60

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Went for my annual echo today at Prince Charles Hospital and my aneurysm cardiologist was very excited in telling me that over the last six or so months they’ve performed 4 - 5 PEARS procedures. At this stage they’re focusing on younger patients and treating it as experimental even though worldwide there have been 200 plus surgeries performed over the last 14 years from memory with overall excellent outcomes.

From what I understand PEARS is used in those with an aortic aneurysm specific to the Root (my situation) also common in Marfan. Even though it still requires opening the sternum / ribs there’s no need to stop the heart and placed on the bypass machine. Much quicker operation with way less chance of complications and a quicker recovery. As it’s basically a wrapper around the existing aneurysm (no removal) there’s not the more invasive surgery resulting in scar tissue etc down the track. Hence if another OHS is needed later in life there’s less risk of complications.

There’s a possibility albeit perhaps low that it may even be an option for me as an older patient if I don’t need surgery for a few years yet and the surgeons there are more confident in the procedure and it’s outcomes both here and abroad.

Otherwise I’m very fortunate that my aortic root aneurysm although around 47 - 48 mm has now been stable for the last three years as of today. One never knows when that could change of course but such is life.

Will be booked in for a stress test in a few months time to see how my blood pressure etc responds to being on the treadmill given I told the Cardiologist I’m much more active with aerobic and resistance now.

Asked about weight training with the response being that’s okay but NO STRAINING.
 
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Gordo60

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I attended an amazing full day Marfan / Genetic Disorders and Aortopathy Conference yesterday in Brisbane (Prince Charles Hospital) with an audience of medical professionals and those with Aneurysm and Genertic Aorta disorders including BAV. Some of the speakers are highly regarded in Australia and Worldwide.

A brilliant presentation was given on PAIRS surgery by the cardiologist heavily involved with it who I also spoke to after the conference.

Here’s the surgeries performed so far in Brisbane since PEARS became available in Australia last year including a 3 year old girl. The intial outcome has been excellent. The cardiologist said that enquires from all over Australia are flooding in regarding patients who might be candidates for surgery. Even in my case the cardiologist said I would likely be a suitable candidate providing all the usual tests are ok:

99F24313-ABD4-4800-AD0A-C261B9C0DAAD.jpeg


Another incredible presentation was given by one of the top aneurysm surgeons (Dr Jalali) in the Country. He specialises in valve sparing surgery including BAV and has a zero mortality rate during all the years of doing it. A huge point was made of the unethical approach many surgeons world wide are taking in not making anywhere near enough effort to reuse / repair the existing valve. His view is that the surgeon should not only be considering the current operation (including NOT simply looking for the quickest / easiest approach) but considering the possibility of future operations. This included doing everything possible to save the valve to avoid a patient having to go on warfarin.

The evidence he showed in regard to mechanical valves / warfarin wasn’t as favourable as other research I’ve seen on this forum. He also said that the short life of tissue valves is still a major concern. He said at times there is no choice but had a very strong view that there are a lot of people who have had aneurysm / valve surgery whose own valve could have been saved / repaired.

Here’s his concluding slide:

40C68D68-9D75-4582-BEE9-DD313D72C2BF.jpeg
 
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Gordo60

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I'd love to know the broader context of that point in Red @Gordo60
Note that the thrust of the presentation was aimed at those with Marfan and other genetic disorders where often there’s an aneurysm but the valve is ok. However it also included BAV. I didn’t get a picture of the slide that showed the global data for aneurysm / valve surgery. I think only about 12 - 15% were done using valve sparing surgery which in his view is disgraceful. I got the impression that Dr Jalali felt this was criminal in his view especially when the American guidelines specify that the valve should be saved / repaired wherever possible. He does repairs on BAV also.

His view is that everything possible should be done to save the native valve given the short life of tissue valves and need for warfarin with mechanical valves. He is also always thinking ahead of the possibility of future operations and plans accordingly. He is one of only a few surgeons in Australia that takes on patients that most other aortic surgeons won’t touch. That is those patients who have had previous multiple surgeries where the future wasn’t taken into account. Quick and easy had been the path by surgeons of previous surgeries resulting in much more difficult operations down the track.

In other words the surgery should take into account the quality of life for the patient over their entire life. He sees far too many quick fixes that are great in the shorter term but create all sorts of issues later on.

I loved his first slide where he said what cardiologists / surgeons often don’t take into account enough is that when you tell someone they have a TIMEBOMB IN THEIR CHEST IT BECOMES A TIMEBOMB IN THEIR HEAD! That needs to be managed also. Because of his level of skill, experience, confidence and excellent track record I felt he preferred earlier intervention depending on the patient. For Marfan that is in the low 40 mm vs the standard 45 mm or more.

As you know when I eventually need surgery I was strongly favouring Dr Jalali based on personal research, your input thanks and my cardiologists recommendation. After seeing his presentation and stats I’d have total confidence putting my life in his hands. PEARS might be an option but I’m not fully confident about it yet and Dr Jalali is also not convinced yet as he wants to see longer term term data which is not there yet. He does like it though in that it’s the only other surgery that spares the valve. But the jury is still out in his mind somewhat to the irritation of the subsequent cardiologist (Dr Whight) presenting on PEARS. Both presentors were extraordinary but I sense there’s quite some rivalry between them.
 

pellicle

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... But the jury is still out in his mind somewhat to the irritation of the subsequent cardiologist (Dr Whight) presenting on PEARS. Both presentors were extraordinary but I sense there’s quite some rivalry between them.
Jalali is quite the guy ... quiet but don't **** with him. The more you learn about what he does the more in awe you are of his drive, his compassion and his dedication.

as to PEARS, one always needs to be careful of "visionaries" ... their product may not live up to (even their) expectation and so they move one (while you're stuck with it).

Uncanny locations:
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Gordo60

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Jalali is quite the guy ... quiet but don't **** with him. The more you learn about what he does the more in awe you are of his drive, his compassion and his dedication.
Yes. I’ve seen a number of Dr Jalali’s patient testimonials describe him as a brilliant surgeon and a humble, kind and gentle man. However amongst his peers as was the case at this conference his ego seemed well intact and he was not backward in expressing his views including disagreeing with other surgeons / cardiologists there. He said at the start of his presentation that some of what he would say might appear arrogant but he has the experience and data to back up his claims.

As mentioned earlier his absolute concern is getting the best lifelong outcome for his patients. This often means that the quick and easy path many surgeons take eg bental procedure where valve sparing surgery could have been done is never the path he would take. His zero mortality rate to date for valve sparing surgery and only one or two reops from memory is impressive to say the least.

Getting back to PEARS his other concern is that because it appears easier it might result in some surgeons who previously should never have been allowed near the aorta attempting to do this operation.

It’s a huge relief for me knowing that when my time for surgery arrives I’ll be able to have this great surgeon do my op.
 

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