I traveled from the US and had PEARS surgery completed by Mr. Conal Austin at London Bridge Hospital last Friday, 8/7/2026. I cannot possibly thank Mr. Austin and the hospital staff enough. Mr. Austin is a gentleman and a scholar - he thoughtfully answered all of my questions, would negotiate healthcare concerns in a meaningful way (more on this later) and genuinely cares about his patients. He reached out after the surgery for get a cup of coffee because he was in the area...he's a fantastic surgeon and great human. The other hospital staff were really all helpful and caring. And, it's a small thing, but the food was great. Due to the extremely high standard of care, I was able to walk out of the hospital a little over 72h after the surgery concluded. The PEARS graft reduced my 48mm root aneurysm to 41mm and reinforced the walls of my aorta to prevent Type A dissection. Other than the root, the rest of my aorta was normal. I also need to thank my wife, whose support was most important in the early days of this diagnosis when it was most emotionally difficult, and our families for their financial support and care of our 3 young children.

This post will be comprised of posts I made while in the hospital as well as my thoughts in the days following about pre- and post-op.

Prior to surgery: One of the hardest parts of the surgery process was figuring out how to get the process started. Thankfully the online user communities (r/aortic_aneurysm and r/marfans) are full of extremely helpful users. I don't want to e-mail drop per-se but there is ONE person responsible handling the logistics of the PEARS program: Alan Rayner. Once I was able to contact him, things started moving.

In terms of health, (1) I do not have Marfan's or a diagnosed connective tissue disorder so your mileage may vary and (2) I'm 41 m, regularly doing athletic competitions (think running, lifting, diving while wearing 40+ lb of equipment) and either lifting or doing cardio every day. Returning quickly to this level of activity was a major factor in pursuing PEARS surgery. Having done research on sternal precautions, mobility restrictions and potential complications, I adjusted my physical training regimen from traditional weightlifting to more functional core training and cardio. I believe this made recovery a bit easier.

In terms of mental health, I wanted to get out of the hospital ASAP (everyone does really) and there is a list of things you need to do before you can leave. I told myself that I was going to (1) treat every one of these milestones as a challenge and crush it + 10% and (2) try to be the most pleasant patient ever because I can only imagine how difficult it is working night shift in a stepdown unit, or how boring it is watching a patient in an ICU. Mindset is very important when committing to surgery. What worked for me, was telling myself that the first stick for the IV is the worst part of the whole thing. You're asleep for all the action, and when you wake up, you're able to control your pain through your clicker. The lines, once in, don't really hurt (even the chest tube, the PICC line which I was somewhat dreading, and urinary catheter, both of which I never really even felt) since they're just plastic and you were asleep when they put them in. I told myself that, when I woke up, I would be at the point of no return: can't go backward, only forward toward recovery and the only alternative is death. It sounds morbid, but the inevitability of discomfort allows you to accept it easier. YMMV of course, but this strategy worked for me and not once did I ever feel depressed or upset in the hospital, or fearful before a procedure, only frustrated that I couldn't sleep well. Hopefully this helps someone.

I arrived in London a week before the surgery. We flew in on Monday and arrived Tuesday in time for pre-op bloodwork, x-ray and echocardiogram. This appointment was mostly in St. Olaf's House, a historical building. London is literally thousands of years old and can trace back to the Roman empire so while the exterior may appear very dated, the equipment itself is top notch.

Day 1 (Surgery): Met with the nurse who will be caring for me. She drew some blood and told me to shave chest and groin. Filled out some forms. Showered after that, had an IV placed, and met with the surgeon and anesthesiologist. I thought I had a slight upper respiratory cold but that turned out to be a non-issue.

In speaking with Mr. Austin, he indicated that the locations of my coronary arteries says this is definitely an aortopathy so surgery is needed. He closed my sternum with Fiber Tape instead of wire. I had asked for titanium plates due to a nickel allergy. This was a happy medium as he knows people in the hospital who use it routinely, and just speaks to his care for patients and willingness to work with them to achieve healthcare outcomes.

"Just woke up in the ICU. No bypass. Feel pretty good actually. I wasn't on the vent when I woke. Chest pain maybe 4 out of 10. Mainly stinging and pain when breathing deep.

Evening, felt well enough to eat some salmon for dinner the food is good. Sternum feels like a bunch of bricks when I breathe. Otherwise no pain to speak or. I had a bradycardia episode and almost passed out not sure why. Off to try snoozing."

Snoozing didn't happen. I didn't sleep a wink in the ICU (kept snoring myself awake like kids do in class).

At this point, I had,

Left arm: IV (arm), arterial line (wrist, for drawing blood, this thing is great...no needle sticks), and my pain management line (hand) - this was hooked up to a clicker that I could engage every 5 minutes (it changes colors to let you know when it's time to party).

Neck: PICC line

Chest: Chest tube, EEG leads

Urinary catheter

One point to make: Some of the stuff I'll talk about sounds painful or unpleasant but truthfully, it wasn't at the time, just uncomfortable, and every time honestly felt better once it was over. They give you tons of lead time for any procedure they're going to do (e.g. removing chest tube) so you can hit your clicker several times beforehand.

Day 2 (Day 1 postop): "Last night I didn't really sleep at all just in and out mashing the painkiller button all night. I'm not sure if the pressure in my chest is from the chest tube or the sternotomy. The physio will be coming shortly to get me up and walking. Hopefully I can get some lines out.

Met with Mr. Austin a moment ago. He said my aorta was very thin in places so he's glad we got this done. He was able to close my sternum with fiber tape as I mentioned, since I'm allergic to nickel. Apparently the sales rep came out to demonstrate and it takes a lot of torque but he's saying it's a great closure, very strong.

I just stood up for the first time. Easier said than done with all the lines in, and required the expert help of two other guys.

Chest tube was removed a little bit ago now having some lunch. It wasn't that bad, the suture was the worst part. Just feels really weird. I can finally breathe fully. Urinary catheter came out which was an extremely unpleasant sensation.

After that it's time for a walk. Did a walk around the ICU and walked some stairs. No issues just need more lung capacity. The physio issued me a spirometer to play with every hour and I'm no longer attached to the lines. Things are looking up.

Day 2 evening. Moving from the ITU was maybe a mistake. Total agony, took a bunch of oral Tylenol and opiates and nothing. Hopefully it passes"

Day 2, early afternoon they moved me to the stepdown unit.

Back to the mindset thing here, originally the plan was to walk a few steps, but knowing stairs came next, just told the physio "it's fine take me to the stairs." Apparently early movement is really important for recovery too so proving to yourself you can do it is important.

The pain thing had to do with losing access to the on-demand IV pain med dispenser around 30 hours postop. The oral meds don't do nearly as much. That said, the pain I was feeling wasn't from laying there, it was from trying to use the wrong techniques to move around in bed. Later, someone gave me this multi-colored hand ladder thing that allowed me to pull myself around the bed and adjust, and this made a huge difference.

Day 3 (Day 2 post-op):

"Day 3 morning. Last night was hell. Eventually figured out that I need more elevation in my bag. Got maybe a couple hours sleep. Also feel like my chest tube stitch is tearing from all the up and down. It sounds trivial but that stitch prevents pneumothorax.

I probably should have waited another day in ITU

Day 3 mid day. Night and day, feeling much better. Got some more lines out, now it's about trying to do the physio routines. Anyone entering into open heart surgery should be prepared for a lot of ups and downs."

In the stepdown unit, they pulled my arterial line and pain management line (left arm, wrist and hand). They had them in there just in case. One thing I should mention - at this point I was on paracetamol and some oral opioid. I did ask if I could stop taking the oral opioid because I know what comes next (massive constipation) but they were pretty adamant about controlling pain, and piling on the laxatives as needed. This strategy was pretty effective, because I didn't end up blocked up after leaving the hospital though going in the hospital was a little sporty.

One of my primary caretakers (a big teddy bear of a man, Mohammed) came in to remove my picc line in the early afternoon. Mo, you were awesome man, thanks for putting up with my insomnia. Lacking any lines, my last day blood draw was a regular butterfly in the arm and I barely felt it, which is not what you expect when the nurse doing the draw is a big dude.

At this point, I had:
Left arm: Cannula

Day 4 (Day 3 post-op):

I was cleared for release around 10 AM, which is ~72h after surgery concluded.

My wife and I took a ride back to the hotel (to be honest I could have walked but we had a few bags and I was self-conscious about walking with my wife loaded down like a pack mule and me carrying nothing lol)

In the hotel gym, I walked 1 KM on the treadmill at 2.5 kph. I thought this was 1 mi at 2.5 mph, which felt awfully slow...realized the mistake at the end of the walk lol. In subsequent days, I changed the settings to Imperial.

Sleeping that night was pretty bad. I couldn't sleep lying flat and couldn't get comfortable. We brought this huge wedge pillow thing that kept sliding my body down toward the middle of the bed creating friction.

Day 5+

Each day gets easier and easier. Every day I'm adding to my walks in the hotel gym (1m, 1.25, 1.5...) in addition to just walkin' around miles, which gets us to around 10k steps a day. My wife left on Day 7 so I've been on my own yesterday and today, and it's fine. Yesterday (a week post-op) I ditched the wedge and was able to just use a few pillows to get comfortable. Initially my lungs were really congested (but too deep to cough it out). Yesterday (8 days post-op) I felt like I could have jogged. I want to jog today but will ask Mr. Austin Monday during clinic when I have my last bit of LBH-issued hardware removed (stitch from the chest tube).

I'm looking forward to going home. Now begins the process of trying to get insurance to pay for the surgery.

What can I do on my own: Dress myself (even t-shirts though stretchy is easier), wipe my own backside (this was never a problem post-op but people get concerned), use more or less unrestricted sternal mobility, carry a water bottle, walk for miles.

What I can't do on my own yet at ~9 days postop: Sleep flat (or well lol), lift or carry >5kg

Addendum: As of Saturday (1 week and a day after surgery), I am side-sleeping again comfortably.

My wife was in town until a week after surgery so I've been on my own the past couple days and it's been fine. To be honest, while it was helpful having her there in case I got stuck putting on a shirt, it probably wasn't necessary. She spent most of the time traveling and shopping, which is great because our room is really small! She'd been wanting to travel more so this was a rare opportunity to see London. While I'm mobile post-op I'm trying to avoid public transport which would have limited our options greatly.

Things to note for US Patients

1. Give yourself time to get the logistics in place. This is probably not an emergency surgery and things WILL come up. We had last minute things come up despite having been planned months in advance.

2. Passport. Check your passport early. I had to expedite the renewal.

3. ETA for UK Travel. This one is new and important. I didn't realize this (nobody did since it's new as of a year or so) but now you need a travel approval to come into the country even just for <6 mo. THERE ARE A TON OF SCAM SITES FOR THIS. A lot of them look legitimate. They take your personal information, do who knows what with it, and file the application for you while charging you 5-10x what it costs to do it through the actual UK app. Do not fall for these schemes. Poke around the contact info and if it redirects to anywhere but UK it's a scam.

4. The CT scan data is really important since that's how they're going to make your implant. It is not easy to find a US hospital familiar with it. There are many versions of the Exstent protocol. Pete Davies is my contact for this and we had to go back and forth a few times to get the correct scanning protocol. I ended up calling, e-mailing, and otherwise badgering the local US healthcare system into letting me talk to senior staff in the radiology department to ensure it would be done correctly, and on the day brought 3 paper copies of the protocol. This worked pretty well.

5. Book your return flight ahead of time. I made the mistake of booking a one-way ticket because I thought there would be a lot of variability in the return flight timing. What I didn't realize is that British Airways charges a hell of a lot more for one way flights than round trips (because we booked several months out, we didn't notice). If I were going to do it again I'd just book the return flight for 2 weeks after surgery. If you need to adjust, it's like $200 as opposed to THOUSANDS. Seriously...ticket here was like $700, ticket home will be over $2,000.

6. I know some people get an Air BNB, but IMO a hotel is the way to go. They'll give you clean sheets and breakfast, have snacks available, and most importantly: AIR CONDITIONING. AC is not standard in the UK, and we've had a heat wave over the past few days breaking 95 degrees. I couldn't imagine being cooped up in a 95 degree room trying to recover. The Residence Inn Marriott London Bridge is where I am staying and it's great.

That's basically it. The user community here is great. Throughout the process I was talking with other folks who had gone through the same thing. Happy to answer questions you guys have.

Hello,

I set the exe to NevadaHD.exe and cfg to nevada.cfg

For some reason, the GVARs shown are all the original Fallout 2 GVARs. I'm trying to fix a bug where Robert's note disappears so you can't progress the quest or get the metal detector, which is pretty important. Thanks in advance.

Has anyone had sternal closure using fiber tape? Recently had my sternum closed with it (Friday) so curious to hear other's experiences.

I wanted to thank everyone in this sub for all the phenomenal information and behind the scenes pro tips toward lining up this surgery. It can be a challenge to navigate to entire process from lining up the consult to getting the CT scan conducted with the correct parameters, to traveling to the UK to dealing with the weeks before you return. People in this group have been extremely generous with their time and experience, and for that I thank you. Not looking forward to it per se, but looking forward to getting it over with.

I'm scheduled for OHS for an unrelated issue but want to check all my boxes. Ive had two CTA with contrast in the past 6 months. Will radiologists generally note stenosis if it exists? The only notes on my reports say no stenosis, but these are noted with respect to valves not coronary arteries. Thanks in advance.

I'm booked for surgery in a week in a foreign country so need to be selective about what to pack. What kind of shirts were best post surgery? I've heard t shirts are good but it seems tough to get them on and off by yourself "in the tube"

Edit: for context I am male

I'm scheduled for PEARS next month for an aortic aneurysm and made the mistake of looking into sternum closure complications - wires breaking, nonclosure issues etc. I'm 41/m work out 5+ days per week, former bodybuilder current athlete. Some of my work and hobbies involve wearing heavy hard plates front and back and a helmet. I'm concerned about potential complications ruining my way of life post surgery. Any success stories from anyone returned to high levels of activity after the sternotomy? Some people say jumping back in too early can cause issues, others say too late can cause issues. The reported rates of complications vary wildly (.3% up to 5+%).

Did Nvision ever update the firmware for the Nox series scopes? Having a reticle that only works at one mag is pretty stupid.

Did nvision ever update the nox35 firmware so that the reticles function as FFP? The version that I have installed, the stadia only work at one magnification and it's pants on head stupid.