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External aortic root support: NICE guidance
  1. Tom Treasure1,
  2. John Pepper2,
  3. Tal Golesworthy3,
  4. Raad Mohiaddin4,
  5. Robert H Anderson5
  1. 1Clinical Operational Research Unit (Mathematics), UCL, London, UK
  2. 2Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
  3. 3Exstent Ltd, Tewkesbury, UK
  4. 4Department of Cardiac Imaging, Royal Brompton Hospital and NHLI Imperial College, London, UK
  5. 5Emeritus Professor, University College, London, UK
  1. Correspondence to Professor Tom Treasure, Clinical Operational Research Unit, Department of Mathematics, University College London, 4 Taviton Street, London WC1H 0BT, UK; tom.treasure{at}gmail.com

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Interventional Procedure Guidance 394 from NICE concerns external aortic root support.1 The work of NICE is rightly regarded world wide as setting the standard in healthcare evaluation, and is to be welcomed by all who desire their practice to be underpinned by evidence, in the best interests of patients. The guidance sets out the evidence to date, and the steps which ‘clinicians wishing to undertake external aortic root support in Marfan's syndrome should take’ in terms of governance, patient information, audit and clinical review. The ‘external stent’ (the term used in the patients' version ‘Understanding NICE guidance’2) is an alternative to ‘conventional management’ which ‘involves preventive surgery to replace the ascending aorta with a prosthetic graft. The aortic valve may also be replaced, or the native valve reimplanted.’

The new procedure completely conserves the valve and blood/endothelial interface. Images of the patient's own aorta are the source of data for computer aided design. A replica of the aorta is used as a former on which an external support is manufactured prior to surgery (figure 1). At operation, performed without the need to open the aorta or to use bypass or myocardial ischaemia, the pliable support is placed …

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