Journal of Cardiac Surgery最新文献

{"title":"Analysis of Factors Influencing Thoracic Deformities after Median Sternotomy in Infants Who Underwent Congenital Cardiac Surgery","authors":"Jian-Feng Liu,&nbsp;Wen-Hao Lin,&nbsp;Yu-Kun Chen,&nbsp;Qiang Chen,&nbsp;Hua Cao","doi":"10.1155/2023/8450105","DOIUrl":"10.1155/2023/8450105","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. To investigate the incidence of thoracic deformities after median sternotomy in infants who underwent congenital cardiac surgery and determine its influencing factors. <i>Methods</i>. This was a single-center retrospective study. A total of 156 infants who underwent congenital cardiac surgery with median sternotomy in a provincial hospital in China from September 2020 to January 2022 were included. Depending on whether thoracic deformities occurred, the patients were classified into the thoracic deformity group and the no thoracic deformity group. Relevant data were retrieved through an electronic medical record system, and statistical comparisons and analyses were performed. <i>Results</i>. The incidence of postoperative thoracic deformities in this cohort was 10.9%. Sternal pins for auxiliary sternal fixation were used in eighty-nine infants. After analysis, it was found that age at operation (1.9 ± 0.9 vs. 3.7 ± 1.2, <i>P</i> &lt; 0.001) and weight-for-age <i>Z</i>-scores (−2.0 ± 0.7 vs. −1.4 ± 0.7, <i>P</i> = 0.001) of the thoracic deformity group were significantly lower than those of the no thoracic deformity group. In addition, sternal pin use was significantly higher in the no thoracic deformity group than in the thoracic deformity group (61.9% vs. 17.6%, <i>P</i> = 0.001). Univariable analysis showed that age at operation (OR, 4.74; 95% CI, 2.38–9.46; <i>P</i> &lt; 0.001) and weight-for-age <i>Z</i>-scores (OR, 4.40; 95% CI, 1.74–11.12; <i>P</i> = 0.002) were significant risk factors for postoperative thoracic deformity. Using sternal pins for auxiliary sternal fixation was an important protective factor (OR, 7.57; 95% CI, 2.08–27.59; <i>P</i> = 0.003). <i>Conclusions</i>. In this study, 10.9% of infants undergoing congenital cardiac surgery through a median sternotomy developed thoracic deformities after surgery. Younger age at operation and poor nutritional conditions may be risk factors for postoperative thoracic deformity. Sternal pin-assisted fixation has a positive effect on the prevention of thoracic deformities.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2023 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/8450105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44589481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical Predictors of New-Onset Atrial Fibrillation after Ascending Aorta Replacement Surgery in Acute Type A Aortic Dissection Patients","authors":"Jian Shi,&nbsp;Yong-Qing Cheng,&nbsp;Xi-Yu Zhu,&nbsp;Ze-Yi Zhou,&nbsp;Yi Jiang,&nbsp;Yun-Xing Xue,&nbsp;Hai-Long Cao,&nbsp;Dong-Jin Wang","doi":"10.1155/2023/2612292","DOIUrl":"10.1155/2023/2612292","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. This study aimed to determine the risk factors of new-onset postoperative atrial fibrillation after ascending aortic replacement in acute type A aortic dissection patients, with emphasis on biochemical parameters. <i>Methods</i>. From Jan 2020 to Dec 2021, a total of 435 acute type A aortic dissection patients who underwent ascending aortic replacement and without a history of atrial fibrillation were retrospectively analyzed in this study. Perioperative data of these patients were obtained from the hospital’s database. The 30-day follow-up was via telephone interviews. The multivariate regression analysis was used to identify risk factors that may be predictive of postoperative atrial fibrillation. <i>Results</i>. 218 (50.1%) patients experienced postoperative atrial fibrillation after ascending aorta replacement surgery. Older age (OR = 1.081 (1.059–1.104), <i>p</i> &lt; 0.001), higher total bile acid (OR = 1.064 (1.024–1.106), <i>p</i> <i>=</i> 0.002), glucose (OR = 1.180 (1.038–1.342), <i>p</i> <i>=</i> 0.012), and serum potassium (OR = 2.313 (1.078–4.960), <i>p</i> <i>=</i> 0.031) were identified by multivariate regression analysis as risk factors of postoperative atrial fibrillation. The multivariate regression analysis prediction model incorporating these four factors had a good prediction effect (AUC = 0.769 (0.723–0.816), <i>p</i> &lt; 0.001). <i>Conclusions</i>. Older age, higher total bile acid, glucose, and serum potassium were risk factors of postoperative atrial fibrillation after ascending aortic replacement surgery in acute type A aortic dissection patients.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2023 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/2612292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64792546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Information Page","authors":"","doi":"10.1111/jocs.15651","DOIUrl":"10.1111/jocs.15651","url":null,"abstract":"","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"4025-4046"},"PeriodicalIF":1.6,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocs.15651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46134542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of direct bilateral axillary arterial cannulation in emergency surgery for acute type A aortic dissection","authors":"Ryo Suzuki MD, PhD,&nbsp;Hiroshi Kurazumi MD, PhD,&nbsp;Ryosuke Nawata MD,&nbsp;Toshiki Yokoyama MD,&nbsp;Kazumasa Matsunaga MD,&nbsp;Sarii Tsubone MD,&nbsp;Yutaro Matsuno MD,&nbsp;Kimitaka Tomisada BS,&nbsp;Bungo Shirasawa MD, PhD,&nbsp;Akihito Mikamo MD, PhD,&nbsp;Kimikazu Hamano MD, PhD","doi":"10.1111/jocs.17175","DOIUrl":"10.1111/jocs.17175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim of the Study</h3>\u0000 \u0000 <p>To assess the validity and long-term outcomes of direct bilateral axillary arterial cannulation for acute type A aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2003 and 2020, 208 consecutive patients with acute type A aortic dissection underwent emergency surgical repair. Cardiopulmonary bypass was attempted to establish direct bilateral axillary arterial cannulation and bicaval drainage. Antegrade selective cerebral perfusion was established by axillary perfusion and direct cannulation of the left common carotid artery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ascending aortic, partial arch, and extended total aortic arch replacement were performed in 50 (24.0%), 7 (3.4%), and 151 (72.6%) patients, respectively. Aortic root surgery and coronary artery bypass grafting were performed concomitantly in 23 and seven patients, respectively. Cardiopulmonary bypass was attempted only through bilateral axillary cannulation in all patients but was successful in 13 (6.3%) patients without bilateral axillary cannulation. No postoperative complications occurred related to this technique. There were seven hospital deaths (early mortality rate, 3.4%). Five patients had postoperative reoperation for bleeding, and nine (4.3%) were transferred to other hospitals due to postoperative permanent cerebral infarction, particularly two with arm ischemia. The 10-year survival rate of patients who underwent emergency surgical repair with this technique was 71.4%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Direct bilateral axillary arterial cannulation followed by selective cerebral perfusion was successful in 93.7% of patients and this may be an optimal solution for providing stable outcomes after emergency surgery for acute type A aortic dissection. However, we experienced two complications of arm ischemia, attention should be paid to potential arm ischemia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"5027-5033"},"PeriodicalIF":1.6,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10537614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of midterm outcomes after Shone's complex surgery: Analysis of reoperation and mortality risk factors","authors":"Firat Husnu Altin MD,&nbsp;Oktay Korun MD,&nbsp;Okan Yurdakok MD,&nbsp;Murat Cicek MD,&nbsp;Yigit Kilic MD,&nbsp;Arif Selcuk MD,&nbsp;Orhan Bulut MD,&nbsp;Emine Hekim Yilmaz MD,&nbsp;Selma Oktay Ergin MD,&nbsp;Ahmet Sasmazel MD,&nbsp;Numan Ali Aydemir MD","doi":"10.1111/jocs.17163","DOIUrl":"10.1111/jocs.17163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The midterm results of patients who underwent biventricular repair surgery for Shone's complex were examined, and mortality and reoperation risk factors were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 34 patients with Shone's complex who underwent mitral valve (MV) surgery between 2005 and 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 19 patients (56%) had coarctation, 10 (29%) patients had subaortic stenosis, 9 (26.5%) patients had a hypoplastic aortic arch (AA), and 9 (26.5%) patients had aortic valve (AV) stenosis. Twenty-four (70.6%) patients had bileaflet AV. Associated left-sided in-flow stenotic lesions included parachute MV in 19 (56%) patients and supramitral ring in 18 (53%) patients. The estimated freedom from reoperation rate on the 6th month, 1 year and 2 years after surgery was 84.4%, 79.5%, and 71.5%, respectively. The overall mortality rate was 20.6% (seven patients) with a median follow-up of 10 months (0–41). The estimated survival rate on the 6th month, 1 year, and 3 years after surgery was 83.8%, 79.4%, and 79.4 respectively. Bicuspid aortic valve (<i>p</i> = .017) (HR (95% CI) = 0.130 (0.025–0.695) and hammock mitral valve (<i>p</i> = .038) (HR (95% CI) = 11,008 (1,146–&gt;100) were associated with mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The presence of a bicuspid aortic valve hammock mitral valve might have an effect on negative effect on the outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"5153-5161"},"PeriodicalIF":1.6,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10537615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subannular procedures on papillary muscles for secondary mitral valve regurgitation repair","authors":"Francesco Guccione MD, PhD,&nbsp;Marco Moscarelli MD, PhD,&nbsp;Roberta Sampognaro MD,&nbsp;Massimo Salardino MD,&nbsp;Daniela Bacarella MD,&nbsp;Nogara Angela MD,&nbsp;Khalil Fattouch MD, PhD","doi":"10.1111/jocs.16968","DOIUrl":"10.1111/jocs.16968","url":null,"abstract":"Mitral valve disease is a frequent cause of heart failure and death. The mitral valve must be seen as a complex apparatus made up of valve flaps, annulus, and subannular structures such as tendon cords and papillary muscles (PPM) (dependent on left ventricular [LV] performance). Emerging evidence indicates that the mitral valve is not a passive structure, but even in adult life remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Functional mitral regurgitation is a condition characterized by mitral regurgitation secondary to an ischemic left ventricle or cardiomyopathy. Primarily, the pathology is the result of the perturbation of normal regional LV geometry combined with adverse remodeling. Although the surgical treatment of severe chronic secondary mitral regurgitation (sMR) in patients presenting for coronary artery bypass grafting (CABG) is recommended by the American College of Cardiology/American Heart Association guidelines, the surgical approach remains debated. Many investigators advocated mitral valve restrictive annuloplasty (RA), meanwhile others have suggested mitral valve replacement. Investigators supporting a conservative approach believe that conservation of the continuity between the valve and left ventricle lead to better long‐term results and a reverse in LV remodeling. 2 | EVIDENCE ON ISCHEMIC MITRAL REGURGITATION (iMR)","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"5434-5438"},"PeriodicalIF":1.6,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of apixaban and rivaroxaban compared to warfarin after cardiac surgery","authors":"Kushal D. Naik PharmD, MBA,&nbsp;Bryan A. Whitson MD, PhD,&nbsp;Eric M. McLaughlin MS,&nbsp;Nancy B. Matre MS,&nbsp;Alan J. Rozycki PharmD, BCCCP","doi":"10.1111/jocs.17203","DOIUrl":"10.1111/jocs.17203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Direct oral anticoagulants (DOACs) are frequently prescribed for the management of atrial fibrillation and venous thrombosis. There is a lack of published data on the utilization of DOACs in individuals who have undergone recent cardiac surgery. The purpose of this study was to evaluate the safety and efficacy of apixaban and rivaroxaban compared to warfarin in patients postcardiac surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, patients were separated into a DOAC cohort or a warfarin cohort based on the agent they received after cardiac surgery. Patients could be included if they were ≥18 years of age and received or were discharged on either rivaroxaban, apixaban, or warfarin within 7 days after cardiac surgery. The primary outcome for the study was the rate of International Society on Thrombosis and Hemostasis (ISTH) major bleeding during hospitalization and for 30 days following discharge or until first follow-up appointment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were a total of 194 patients included in the analysis, 97 in the DOAC cohort and 97 in the warfarin cohort. Four patients (4.1%) in the DOAC group experienced ISTH major bleeding, while 2 patients (2.1%) in the warfarin cohort experienced ISTH major bleeding (<i>p</i> = 0.68). No patients in the DOAC cohort experienced a thrombotic event, whereas 2 patients (2.1%) in the warfarin cohort experienced a thrombotic complication (<i>p</i> = 0.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Apixaban and rivaroxaban demonstrated similar safety when compared to a matched cohort of warfarin patients. Larger prospective randomized studies are needed to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"4740-4747"},"PeriodicalIF":1.6,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10107629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: \"Urinary TIMP-2 and IGFBP-7 protein levels as early predictors of acute kidney injury after cardiac surgery\".","authors":"Suhaib Ahmaed, R. Memon","doi":"10.1111/jocs.16736","DOIUrl":"https://doi.org/10.1111/jocs.16736","url":null,"abstract":"The journal's article \"Urinary TIMP-2 and IGFBP-7 protein levels as early predictors of acute kidney injury after cardiac surgery\" piqued our attention. This article is protected by copyright. All rights reserved.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43356102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe heart flush technique during recovery from donors after circulatory death.","authors":"Magdy M El-Sayed Ahmed,&nbsp;Kevin P Landolfo,&nbsp;Samuel Jacob,&nbsp;Basar Sareyyupoglu,&nbsp;Mathew Thomas,&nbsp;Si M Pham,&nbsp;Ian A Makey","doi":"10.1111/jocs.17023","DOIUrl":"https://doi.org/10.1111/jocs.17023","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death is the donation after cardiac arrest. This technique has been employed and adopted by clinicians to overcome the shortage of available hearts for transplant. Warm ischemia time plays a pivotal role in the survival outcome of the heart recipients.</p><p><strong>Aim of the study: </strong>To assess the efficacy of using the Foley catheter to flush the heart during procurement from donation after circulatory death donors.</p><p><strong>Methods: </strong>We utilized a 2-WAY Foley catheter to flush the heart during procurement. The catheter was prepared and modified on the back table.</p><p><strong>Results: </strong>We were successfully able to flush the heart within 3 minutes from skin incision with a good recipient outcome.</p><p><strong>Conclusions: </strong>Using the Foley catheter to flush the heart during recovery from donation after circulatory death donors was both efficient and fast.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"5646-5648"},"PeriodicalIF":1.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/2a/JOCS-37-5646.PMC10092136.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9350534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dawn of surgical treatment of aortic insufficiency.","authors":"Igor Vendramin,&nbsp;Uberto Bortolotti,&nbsp;Aldo D Milano,&nbsp;Ugolino Livi","doi":"10.1111/jocs.16851","DOIUrl":"https://doi.org/10.1111/jocs.16851","url":null,"abstract":"“Failure is success in progress” ‐ Albert Einstein (1879−1955) Before the development and introduction in the clinical practice of the heart‐lung machine in 1953, to allow intracardiac procedures to be performed under cardiopulmonary bypass (CPB), certain cardiac operations could be accomplished only on a beating heart under mild hypothermia or with the use of cross‐circulation, as utilized by Walton C. Lillehei to successfully repair even complex congenital heart malformations. In 1953, Hufnagel (Figure 1) and Harvey reported the successful implantation of a ball valve prosthesis into the thoracic aorta (Figure 2). This historical operation was performed on September 11, 1952 at Georgetown University Hospital in Washington, DC, in a female patient with severe aortic valve insufficiency. This device, designed to replicate the mechanism of a liquor bottle stopper, produced almost one century ago, consisted in a tubular chamber, with an inlet and an outlet, containing a hollow ball to reduce its gravity; indeed, a pressure of just 5 mmHg was enough to move the poppet in a completely open or closed position. The whole device was molded from a single piece to obtain a smooth surface. Initially, the entire prosthesis was made of methyl methacrylate (Lucite); subsequently the ball was changed with one made by a hollow nylon core covered by silicone rubber to reduce prosthetic noise. As Hufnagel himself stated: “This valve was developed for the treatment of aortic insufficiency and to serve as a prototype to test the possibility that a valvular prosthesis would satisfactorily function within the cardiovascular system.” In those years the CPB machine was still unavailable while replacement of the ascending aorta had not yet been performed. Therefore, Hufnagel was forced to insert this device into the descending aorta and implanting a prosthesis in that location was certainly made possible by the demonstration that the thoracic aorta could be safely temporarily clamped, as occurred during the first landmark operations performed by Robert Gross to close a patent ductus arteriosus or repair an aortic coarctation. The operation to implant the Hufnagel prosthesis was performed through a standard posterolateral thoracotomy incision through the 5th intercostal space with the patient placed in the right lateral decubitus. As described by Hufnagel himself, the prosthesis was implanted in the descending aorta just below the takeoff of the left subclavian artery. Toinsert the prosthesis (Figure 3), following proximal and distal cross‐clamping, a transverse segment of the descending thoracic aorta was excised and the prosthesis inserted into both cut ends of the aorta; the prosthesis was fixed in place using flexible rings at the grooves present on the outer surface at both ends of the valve; occasionally, at the end of the procedure the aorta was wrapped with fabric material. Details of the operation, with some technical modifications, have also been described in t","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"37 12","pages":"5676-5678"},"PeriodicalIF":1.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9279340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}