Surgery of the Aortic Valve Before the Era of Cardiopulmonary Bypass

Abstract

At the end of the 19th century, Stephen Paget and Theodore Billroth affirmed the unprofessional and unethical nature of the surgical approach to the human heart, with cardiac surgeons “losing the respect of their colleagues”. 9 September 1896 is thus frequently not universally considered the birth of cardiac surgery, with the first successful repair of a right ventricular stab wound by Ludwig Rehn, a German surgeon. Lillehei and colleagues noted that “the outer wall of the living human heart represented a seemingly impenetrable anatomical barrier to the surgeon’s knife”. The challenge for the cardiac surgeons was to cross this barrier. The conquest of aortic valve surgery was carried out step by step: a blind approach first, followed a few years later by plasties under direct vision (allowed owing to techniques of hypothermia and bicaval clamping), leading to the avanguardist concept of aortic valve prosthesis implanted without cardiopulmonary bypass (CPB) by Hufnagel. Nowadays, trans-arterial aortic valve implantation is performed by the HEART TEAM, an association of surgeons, interventional cardiologists, echocardiographists and anaesthesiologists in a hybrid operating theatre.

On ne connaît pas complètement une science tant qu’on n’en sait pas l’histoire.

Auguste Comte