However, the standard options open to him, a Bentall graft or valve sparing surgery, did not appeal. Both were major surgical procedures and the Bentall graft required a lifetime on anticoagulant drugs.
As a chartered engineer with a lifetime in research and development engineering, Tal attended a Marfan Association UK Information day in 2000 to listen to a presentation by Professor Tom Treasure on aortic surgery. At the end of the presentation, Tal engaged Professor Treasure in discussions on an alternative approach and the idea to externally support the aortic root arose.
Professor John Pepper joined the project, Tal raised finance and in 2002 Tal and engineers at Imperial College started work. In 2003 the Local Research & Ethics Committee at the Royal Brompton Hospital gave approval for a clinical trial and in May 2004 Professor Pepper implanted the first ExoVasc® in Tal, who was the first patient to receive the implant.
In 2009, after successful implantation of the ExoVasc® support in 19 patients, the Clinical Practice Committee at the Royal Brompton Hospital approved the device for use in the treatment of suitable patients with a dilated aorta due to Marfan syndrome.
In 2011, following a consultation process, the National Institute for Clinical Excellence issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on External aortic root support in Marfan syndrome. This guidance was updated in May 2022. (To read the latest guidance visit https://www.nice.org.uk/guidance/IPG724.)
The procedure to implant the ExoVasc® Personalised External Aortic Root Support has been adopted by 31 surgical centres and more than 500 patients have had the implant fitted.