"It Will Work": The Story of Nina Starr Braunwald and the First Successful Mitral Valve Replacement.

Cardiothoracic surgery is a clinical and scientific discipline that has evolved enormously over the last decades. Cardiac problems that were historically death sentences can now be addressed with approaches that only continue to improve. In the late 1950s, while cardiothoracic surgery was still a nascent field, Nina Starr Braunwald emerged as a pioneer for this exponential improvement. As the first woman cardiac surgeon in an era in which general surgery and surgical specialties were dominated by men, Dr Braunwald not only made revolutionary contributions to cardiothoracic surgery, but also did so while balancing roles as a dedicated mother and supportive partner.

The early days of vascular and heart valve prostheses: a historical review.

This surgical heritage article provides a historical overview of the most important early advances of vascular- and valvular surgery, that lead to the development of currently used vascular- and valvular prostheses and materials. The first writings describing techniques in vascular surgery mainly focussed on hemorrhage control and date from around 1600 B.C. The strategy of vessel ligation was first mentioned in Western literature around 200 B.C. In the 18th century, techniques of ligation were expanded towards attempts of vessel restoration. The first artificial vascular prosthesis was made in 1894. From this time on, vascular prostheses were used in animal experiments and around 1900 for the first time in humans. More than 60 years later, in 1952, the first mechanical heart valve prosthesis was implanted. Four years later, the first successful biological heart valve implantation followed. In 2000, a transcatheter heart valve was successfully implanted in a human for the first time. Over time, procedures and techniques became more efficient and effective. This led to new developments, such as the manufacturing of a tissue engineered blood vessel in 1986. Nowadays, dozens of different valve prostheses have been devised, both mechanical and biological. Still, no ideal model of vascular and heart valve prosthesis exists.

How Did We Get Here?: A Historical Review and Critical Analysis of Anticoagulation Therapy Following Mechanical Valve Replacement.

Managing severe valvular heart disease with mechanical valve replacement necessitates lifelong anticoagulation with a vitamin K antagonist. Optimal anticoagulation intensity for patients with mechanical valves remains uncertain; current recommendations are inconsistent across guideline bodies and largely based on expert opinion. In this review, we outline the history of anticoagulation therapy in patients with mechanical heart valves and critically evaluate current antithrombotic guidelines for these patients. We conclude that randomized trials evaluating optimal anticoagulation intensity in patients with mechanical valves are needed, and that future guidelines must better justify antithrombotic treatment recommendations.

The Stented Porcine Bioprosthesis: A 50-Year Journey Through Hopes and Realities.

The year 2018 marked the 50th anniversary of the first implant of a commercially manufactured stented porcine bioprosthesis. During the subsequent years considerable clinical and pathologic research was done to evaluate the overall performance of such devices and to identify the leading causes of failure. This brief review covers 5 decades, summarizing the initial hopes and the realities faced by surgeons who have believed from the start in these cardiac valve substitutes. From reported failures and long-term results a new generation of durable and reliable stented porcine bioprosthetic valves is currently available.

Minimally invasive cardiac surgery in Japan: history and current status.

This review examines the historical and current status of minimally invasive cardiac surgery (MICS) in Japan, based on reports that have been published in English. Although enthusiasm for MICS in Japan increased during the 1990s, it waned during the early 2000s because of various limitations. However, the introduction of minimally invasive mitral valve surgery, aortic valve replacement, atrial septal defect closure, and coronary artery bypass has led to the resurgence of MICS in Japan during recent years. Academic societies and a national registry system will play an important role in ensuring that this new wave of MICS is implemented safely and effectively. Off-the-job training and team building are also key factors for implementing a successful MICS program.

Nina Braunwald: A Female Pioneer in Cardiac Surgery.

Nina Starr Braunwald, the first female cardiac surgeon, made headlines during a time when almost all specialty surgeons were men. Women have typically been deterred from entering surgical specialties, in part because of their traditional dual burden of managing their households and careers. Instead, female medical students and junior doctors have tended to be more attracted to medical specialties. This was the reality during Dr. Braunwald's venture into medicine in 1949. However, she never allowed negative ideas to keep her from joining a surgical training program. Under the mentorship of the prominent cardiac surgeons Charles Hufnagel and Andrew Morrow, Dr. Braunwald progressed in her career by conducting research that led to her development and implantation of the first prosthetic mitral valve. She was also a great teacher. Dr. Braunwald balanced her personal and professional activities admirably, and her example still inspires female doctors to consider careers in cardiothoracic surgery. In this report, we provide details of her impact on cardiac surgery and insights into her successes.

[Boris Vian and his failed meetings with cardiology]. / Boris Vian. Ses rendez-bous manqués avec la cardiologie.

Boris Wan, a mythical figure of the post war years, just missed the succession of therapeutic advances in cardiology in the mid of the XXth century. A acute articular rhumatism occurred in 1932, as penicillin, discovered in 1928, was not yet on the market. Aortic regurgitation followed. On July 20, 1955, a pulmonary edema occurs as the first case of open-heart surgery with extra corporeal circulation is performed by Charles Dubost in 1955. But only the aortic stenosis may benefit from this surgery. Regarding aortic regurgitation, an artificial valve is necessary. The first Starr-Edwards heart valve is implanted on August 25, 1960. June 23 , 1959, Boris Wan made a sudden loss of consciousness probably due to a ventricular fibrillation. It is this same year that the electric shock is used for the first time, but only in hospital. Boris Wan died during transport to the Laennec hospital. Ambulances were not yet equipped with defibrillator.

Sir Donald Ross, pioneer aortic valve surgeon.

Tribute to Sir Donald Ross by David Wheatley, as read by Robert Kleinloog, President, Society of Cardiothoracic Surgeons of South Africa at the Annual Congress of the South African Heart Association 19 October 2014.

Bernoulli in the operating room: from the perspective of a cardiac surgeon.

The Bernoullis were one of the most distinguished families in the history of science. It was Daniel Bernoulli who applied mathematical physics to medicine to further his understanding of physiological mechanisms that have an impact even in today's high-end medicine. His masterwork was the analysis of fluid dynamics, which resulted in Bernoulli's law. Most important for cardiac surgery, it describes how a centrifugal pump works within an extracorporeal circulation, lays the basis for measuring a gradient over a stenotic heart valve, and explains how to measure the transit time flow within a bypass graft.

Hugh Henry Bentall, a pioneer of cardiovascular surgery.

Hugh Henry Bentall, the inventor of the surgical procedure that enabled concomitant replacement of the aortic valve and ascending aorta, died on September 2012 at the age of 92. He was the first Professor of Cardiothoracic Surgery in the United Kingdom, at the Hammersmith Hospital, and carried out the first open-heart operations with a heart-lung machine in London in 1953. Besides cardiac surgery, he paid particular attention to cardiac anatomy and embryology, which he enriched even following retirement. He leaves three sons and a daughter.

Transcatheter aortic valve replacement: history and current status.

Despite the poor prognosis associated with severe, symptomatic aortic stenosis, treatment options were limited for a large subgroup of patients deemed high risk for surgical replacement. The introduction of transcatheter aortic valve replacement (TAVR) over the past 10 years marks a new and exciting era in the treatment of valvular disease in these high-risk and inoperable patients. In this review, we outline the historical development, key clinical trials, current outcomes and future directions of TAVR.