Figure 1. From left to right the figure illustrates the design, manufacture and implantation of the ExoVasc personalised mesh support. Digital image (a) is used to make a 3D replica (b) of the patient’s aortic root and ascending aorta. On this a customised sleeve of an open mesh fabric is manufactured (c). Each stage requires expertise and time is measured in hours. The aorta is dissected down to the aortoventricular junction (d). The dissection extends proximal to both coronary ostia. The longitudinal seam in the mesh is opened and incisions made to the point where the coronary arteries must pass through fashioning asterisk shaped incisions to conserve the mesh support. It extends to the aorto-ventricular junction and distally to just beyond the brachiocephalic artery (e). The final picture (f) is of the image of the first recipient (TG) 15 years after the operation.