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pregnancy. Rolon’s aortic root has grown to4.7cm in diameter. In most adults, it’s about 3cm.

If she lived almost anywhere else in theworld, including the US, Rolon would havefaced an agonising choice. She could continuewith her pregnancy, putting her own life in jeop-ardy, and potentially leaving her son, who wasstill a baby, to grow up without a mother. Or shecould be placed on a heart-lung machine, herbody temperature lowered to 18 degrees Celsius,for an operation to replace her aortic root withartificial tubing, and probably the aortic valve aswell, swapping it with a man-made alternative.Doctors must stop the heart temporarily duringthe surgery, which lasts about six hours. Butthat would have meant the almost certain lossof the child she was carrying and a lifelong reli-ance on anticoagulant medication.

In Queensland, Rolon had a third option. AtThe Prince Charles Hospital, in the northernBrisbane suburb of Chermside, a 40km drivesouth from Rolon’s home, Tesar and colleagueDr Livia Williams, had just introduced an alter-native operation, dubbed the PEARS pro-

ael and, unexpectedly, is pregnant with her sec-ond. Her doctors are worried.

The then 21 year old from Caboolture,north of Brisbane, has a ticking time bomb in-side her chest. Rolon has Marfan syndrome,a genetic disorder of the connective tissue, af-fecting about one in 5000 people. Those withthe condition are characteristically tall andslender, with long arms and legs. They fre-quently have issues with their eyes and bones,but it’s how the disorder affects their hearts thatis life-threatening.

The heart is essentially a living pump. Inits centre is a piece of pipe known as the aorticroot, which dilates in Marfan patients, puttingthem in danger of a fatal rupture as theyage. Tesar describes it as a bit like a balloon be-coming increasingly likely to pop the more airthat’s blown into it.

Women with Marfan syndrome are particu-larly vulnerable while pregnant. Higher levels ofthe hormone relaxin are produced, softening theaortic root and causing it to stretch further. Therisk of it tearing or bursting mounts with each

PETER Tesar is home alone inBrisbane, staring trance-like atthe ceiling. One of Australia’sleading heart surgeons, hementally rehearses the opera-tion dozens of times beforethe real thing, practising every

tiny movement, every incision. It’s a ritual theveteran of about 12,000 operations goesthrough leading up to every complex surgery,something he likens to elite athletes visualis-ing a winning performance to prepare theirbodies for success. Olympic divers, he says,imagine every twist and turn, every tuck,well before they begin their climb to the top ofthe 10m tower.

But for Tesar, in his mid-sixties, there’s muchmore at stake than an Olympic gold medal. In afew weeks, he’ll have the beating heart of ayoung woman in his hands, the life of her un-born child dependent on his skill. The surgeryhe’s about to attempt has never been tried on apregnant woman anywhere in the world.

Jasmine Rolon already has one child, Raph-

The gift of

lifeJasmine Rolon was the first

pregnant woman in the world to undergo groundbreaking heart surgery to repair her aorta. Five

days later, she was given the joyous news that her baby

had survived

Story JANELLE MILES

CYCLE OF LIFE: Jasmine Rolon, who has Marfan syndrome, with her daughter Luna, her miracle baby. Picture: Mark Cranitch

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Queensland is the only Australian state witha formal PEARS program, although three ofthe procedures have been done in Melbourne.The concept is relatively straightforward – 3Dprinting technology is used to create a model ofthe weakened section of aorta, based on de-tailed CT scans. A made-to-measure polyestermesh sleeve is then fashioned to fit over the pa-tient’s aortic root and valve, fortifying the at-risk areas. Simply put, it’s a plumbing fix –rather than replacing a leaky pipe, it’s bolsteredwith scaffolding. In this case, the mesh becomesincorporated into the outside wall of the aorta,strengthening the main artery that suppliesoxygen-rich blood to the rest of the body.

Hailed as a major advance in heart surgery,the idea for the PEARS procedure came notfrom a doctor, but from British engineer, TalGolesworthy, who has Marfan syndrome him-self. When Golesworthy learned he requiredaortic root replacement surgery or face an in-creasing risk of premature death, he was unim-pressed with what was on offer, particularly the

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For me, it was like the cycle of life had to continue. I’ve got to do this for my baby.

cedure – an acronym for Personalised ExternalAortic Root Support. Most PEARS surgery isperformed without the need for a heart-lungmachine, giving the young mum the chance tosave her unborn baby. But with the operationnever having been performed on a pregnantwoman before, there were no guarantees.

“I was kind of like: ‘I don’t know what thehell is going to happen here’,” Rolon says. “Icould have easily pulled out at any time. But Ihad to really stick to my guns. I had to weighup the pros and cons and, obviously, PEARSwas the best option. For me, it was like thecycle of life had to continue. I’ve got to do thisfor my baby.”

Her surgery could not have come at a morestressful time for Rolon’s family who weregrieving the death of her younger brother,Jesse. The much-loved 15 year old died sud-denly on Anzac Day last year.

Rolon was acutely aware of how muchworry she had created leading up to the opera-tion on top of Jesse’s loss. “It was awful,” shesays through tears. “That was the hardest bit forme.” But at the same time, the mature youngwoman, who lives by the mantra “Be Positive”,knew she had to remain upbeat for the sake ofthe life she was carrying inside her.

“Feeling sorry for yourself does nothing foryou,” Rolon says. “I was pregnant with a littlebaby that’s going to be feeling what I’m feeling.Obviously in your head, maybe subconsciously,you’ve got all these emotions but I was trying toactively not feel that. I’ve worked hard to makemyself relaxed. If you stress, it really is feltby everyone around you. I justkept telling myself it was allgoing to work out, it was allgoing to be good.”

A picture of Jesse sits on ahallway table in the entrance toRolon’s home. Just days afterhis funeral, Rolon nervouslytold her Mum Gabriela Clark-son of her surprise pregnancy.Her first child, Raphael, was notyet six months old. It was Moth-er’s Day, 2019. “She was scaredto say something,” Clarkson re-calls. “It came at a difficult time.But it was beautiful. It was thebest news in the world becausewho wouldn’t want more lifewhen we’d just lost somebodyso precious?”

Nevertheless, mixed with thejoy for Clarkson was the worry for her onlydaughter and how her heart would cope with asecond pregnancy. At that stage, the possibilityof the PEARS procedure had not been raised.

Clarkson only learned of Rolon’s plan to havethe surgery once the decision had already beenmade. She had no choice but to trust her inde-pendent, headstrong first-born and put herfaith in a surgical team she had never met.

“Jasmine always said to me: ‘The PEARSpeople are so good, Mum. We don’t need toworry. I’ve asked all the questions. They’ve toldme everything I need to know’,” Clarkson says.“She’s so informed in everything. She’s over thetop in her investigations and was very much:‘I know what I’m doing’.”

Almost 350 PEARS procedures have beencarried out in 10 countries at 28 surgical centressince the first in the United Kingdom in 2004,including 20 at The Prince Charles Hospital.Eight have also been performed at the Queens-land Children’s Hospital in South Brisbane.

prospect of spending his life on blood-thinningdrugs. There had to be a better way, he thought.

In a case of patient heal thyself, he came upwith the idea for the PEARS implant, built atechnical team, raised capital and became theguinea pig for the first operation in May, 2004,performed by Professor John Pepper at Lon-don’s Royal Brompton Hospital.

Now 63, Golesworthy, has been working onthe PEARS project for 20 years after a previousbackground in coal combustion research anddevelopment. He’s the technical director of Ex-stent Ltd, a small medical engineering companybased in Tewkesbury, Gloucestershire, wherethe mesh implants are manufactured. The ideafor the material used in the PEARS implantcame from knowledge he gained during his coalindustry days working with fabric filters.

Golesworthy’s invention has undoubtedlychanged lives, including his own. But speakingby email from Gloucestershire, his frustration isevident. Remaining committed to the project tohelp others has taken a personal toll.

“I frequently say to others involved inPEARS, how I wish they could have met me20 years ago when I was a happy-go-lucky en-gineer involved in interesting R and D ratherthan a burnt-out, worried old wreck,” he writes.Had he known how much “blood, sweat, tearsand grief” the journey would entail, he says hemay never have embarked on it in the firstplace. “Of course, when I started … I was self-ishly focused on fixing myself,” Golesworthysays. “Unfortunately, I’ve spent over 20 yearscommitted to this project out of a sense of re-sponsibility to my fellow travellers. A laudableendeavour but one that has demanded a signifi-cant price from me.”

Innovation in medicine is a painfully slowprocess, the surgical profession renowned forits conservatism. The acceptance of new proce-dures can take years, often decades, and is gov-erned by regulation to protect patient safety.

Golesworthy has had to be extremely pa-tient, initially “entirely ignorant” of how stub-born to change many surgeons can be and thestringent rules they operate under. But twodecades on from his original idea, as more sur-geons embrace the PEARS procedure with ac-cumulating evidence of its effectiveness andsafety profile, the company he created is pre-paring to expand. “With a bit of luck, I will beable to reduce my workload and focus on thoseparts of the business that I enjoy,” he says.

The Prince Charles Hospital started aPEARS program in March last year with Tesar,its former director of cardiothoracic surgery, atthe helm. Tesar wears a scrub hat like a paint-er’s beret, wielding a scalpel with as much skillas the French masters had with their brush-strokes. He’s an expert in aortic surgery andwhile the concept behind the PEARS pro-cedure is relatively simple, the technical chal-lenges of fitting the implant over the aortic

root and valve while the heart is still beating,are enormous. “The PEARS procedure it-self is an operation for the few,” he says

SAFE HANDS: Cardiothoracic surgeons Dr Livia Williams and Dr Peter Tesar; a CT scan showing the displacement of Jasmine Rolon’s heart to the far left side of her chest; a mesh sleeve was created to fit over Rolon’s aortic root and valve for the PEARS surgery. Picture: David Clark

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without a hint of arrogance. “Not every sur-geon should do it. To evolve this as a patientoption, it’s important to leave it to a few teamsthat develop the expertise to do it well, safely,with low mortality risk.”

Jasmine Rolon was about 14 weeks’ preg-nant when she was wheeled into the operatingtheatre for the two-hour procedure in July,2019. Her case posed significant difficulties, notthe least being she was expecting a baby.

Dr Livia Williams, one of just two femaleheart surgeons in Queensland and herselfmum to a toddler, assisted Tesar in the world-first surgery. Accessing Rolon’s aorta to per-form the procedure was particularlydemanding. Because of her Marfan syndrome,Rolon had what’s known medically as a pectusexcavartum – her breastbone was sunken intoher chest. The severity of her condition madethe PEARS procedure particularly complexfrom an anatomical perspective. Typically, theheart sits in the centre of the chest, slightly tothe left of the breastbone. In Rolon’s case, itwas “completely displaced to the left chest cav-ity”. “The view was very poor,” Williams says.Instead of being able to operate looking downonto the heart after sawing through the ster-num, they had to lift up one side of the boneand operate looking in from the side.

Williams did not enter medical school to be-come a surgeon. Her first dream was to joinMedecins Sans Frontieres, Doctors WithoutBorders, to perform humanitarian work. Atage 20, she took a year off medicine to live inNarsapur, a village in India, collecting data aspart of a study into factors contributing to still-birth and deaths among babies in the earlyweeks of life. But after returning to Mel-bourne’s Monash Medical School, the formerstudent of Pimlico State High School inTownsville, was hooked on surgery from themoment she first entered an operating theatre.“I felt at ease,” she says. “I just really enjoyedoperating, the physical act of operating.”

Now in her 30s, Williams has been a cardio-thoracic consultant since 2016, choosing heartsurgery because of the intricate, technical na-ture of the work, describing the complexity as“very intellectually satisfying”. “For this type ofsurgery, the needle that you use to do the oper-ation is smaller than your eyelash and the su-ture is thinner than a strand of hair,” she says,borrowing a quote from a fellow heart surgeon.

“I enjoy the intensity, the fact that decisionshave to be made extremely quickly in the oper-ating theatre and events can happen suddenly.You have to draw on a huge amount of experi-ence within a couple of seconds to salvage situ-ations.” She went into heart surgery despite itremaining, even in 21st-century Australia,largely a male domain, growing up in a house-hold where she was encouraged to followwhatever career path she wanted.

Under Tesar’s guidance, Williams is beingtrained to take over the PEARS program oncehe inevitably hangs up his scrubs. With theprogram well established at The PrinceCharles Hospital – Queensland’s premier pub-lic heart treatment facility – Tesar and Willi-

ams share the load of being prime surgeon. Butthey only ever perform the procedure whileboth surgeons are in the operating theatre, oneassisting the other. “We never do it when oneof us is out of town,” Tesar says. “It’s only everdone as a complete team, because that givesyou the safety margin that the process is doneas perfectly as we can make it.”

Rolon’s surgery was planned in detail before-hand. “Like every good operation, you’ve actu-ally done it 100 times before you enter theoperating theatre … contemplating all themovement systems, going through all the pha-ses of play, including options for variation, ac-cording to need,” Tesar says. They had tochange how they would typically operate to ac-count for the anatomical challenges of their pa-tient. Instead of performing the procedure withthe two specialists facing each other across theoperating table, they worked side-by-side.

Surgeons, like many elite sportsmen andwomen, have their routines. Tennis great Ra-fael Nadal avoids walking on the lines of thetennis court before and after every point. Tesaronly enters the operating theatre once the pa-tient is prepped and draped. The ritual is partof how he “dissociates”, allowing him to focussolely on the complex job ahead. “Everything’smapped out,” he says. “How you gear yourselftowards making sure you are getting that littlebit of set-up angst within you so you knowyou’re keyed in, it’s all planned.”

The temperature of the operating theatre isset at 17.9C. “People have actually shown thatmental performance is greater when it’s a bitcooler,” Tesar explains “You actually designthe environment for maximum performance.”

Under the extreme stress of an operatingtheatre, independent of how unflappable sur-geons may appear externally, studies havefound their heart rates generally jump toaround 150-170 beats per minute – the averageadult’s resting heart rate is between 60-100beats per minute. Even in highly-pressurisedsurgical situations, Tesar appears calm, hisvoice measured. His demeanour is one of hissurgical strategies for optimal outcomes.

“When you’re running an operating theatre,if the prime surgeon is not calm, then people intense situations will lose their cool,” he says.“During the high-risk components of opera-tions, you make it quiet. When you give ordersor requests, everything is done with a soft tone.It means people have to concentrate but also, itdoesn’t stress people.”

Rolon went into the surgery not knowingwhether her unborn baby would still be alivewhen she woke up. She had to sign a consentform allowing her doctors to switch her to aheart-lung machine during the procedure ifnecessary – a scenario that would have meantthe almost certain loss of her child. Still, sheknew the PEARS procedure offered the bestchance of saving both their lives. As it turnedout, Tesar says, the operation went “mostly” toplan. It was only towards the end of the surgerythey struck the biggest problem: they were un-able to close her chest without her blood pres-sure dropping – a result of her pectusexcavartum. In a dramatic, but successful, endto the operation, they drew on the expertise ofanother cardiothoracic surgeon at The PrinceCharles Hospital, Dr Rishen Naidoo, who hadto break bones to realign Rolon’s rib cage, al-lowing her chest plate to be closed.

It would be five days before Rolon knew herbaby was safe. As she lay in The Prince CharlesHospital’s intensive care unit recovering fromthe surgery, in pain and struggling to sleep, thenormally “chilled” young woman’s mind wan-dered. “In my head, I was like: ‘Maybe mybaby’s dead’,” she says. “That was when it wasstressful. Your brain goes everywhere. MyMum was coming to see me every day but Iwasn’t telling her that was happening because Ididn’t want to make anyone sad.”

It wasn’t until Rolon had an ultrasoundafter leaving ICU, allowing her to hear thethump, thump, thump of her baby’s heartbeat,she was able to finally relax. “I was like: ‘Oh myGod, thank God, my baby’s alive,” Rolon re-calls. “Everything was normal.”

And here she is, baby Luna, snuggled in hermother’s arms. About five months afterRolon’s world-first surgery, Luna was born bycaesarean section at the Royal Brisbane andWomen’s Hospital on December 20 – her fam-ily’s ultimate Christmas gift. The little girl, de-scribed by her Mum as “my miracle baby”, wasfour weeks early but weighed a healthy 3165g.

Rolon, who turns 23 in October, recently re-turned with Luna to The Prince Charles Hos-pital for an appointment with her surgicalteam. “You look good,” Tesar says. “You’vecome through all this pretty much unscathed.Is it hard having two?” he asks. “Sometimes,”she replies. “But I have very relaxed babies.”

“Life goes on, which is how it should be,”Tesar says. “We’re actually itinerants in peo-ple’s lives. What should happen if things gowell is that we leave and people then live theirlife, not live their disease.”

“Thank you very much,” Rolon replies, cud-dling her daughter. “Just live,” Tesar tells her. ■* To donate to heart research at The Prince Charles Hospital Foundation: thecommongood.org.au

POSITIVE OUTCOME: Jasmine Rolon, 22, with daughter Luna and son Raphael, is forever thankful to The Prince Charles Hospital’s surgical team. Picture: Mark Cranitch

In my head, I was like: ‘Maybe my baby’s dead’. That was when it was stressful.

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