Hufnagel revisited: A descending thoracic aortic valve to treat prosthetic valve insufficiency

Marrow Stromal Cell based Stem Cell Based Transcatheter Aortic Valve Implantation: First Experiences in a Preclinical Model

“…Based on previously described techniques that are currently entering the clinical-arena following recent FDA approval [11] to generate tissue-engineered vascular-grafts (TEVG) by using BMMCs without any phase of in-vitro culturing or expansion [12][13][14][15][16], we successfully generated and implanted autologous BMMC-derived TEHV in a one-step intervention comprising cell-harvest, in-vitro engineering and transapical-delivery [10]. However, except an acute, technical feasibility study using a modified Hufnagel procedure [17] to implant TEHV into the descending aorta in an ovine model [18], chronic studies of successful TEHV-implantations have only been reported for the low-pressure system in the pulmonary-position [9,10,19].…”

The dawn of surgical treatment of aortic insufficiency

“…10 The Hufnagel caged-ball prosthesis was viewed more like an aortic-assist device, since it did not replace the aortic valve, but was mainly designed with the aim of assisting patients with significant aortic valve incompetence; indeed, it reduced significantly aortic regurgitation but could not completely control "all of the aortic leaks" because the poorly functioning native aortic valve remained untouched; nevertheless, in many patients clinical improvement occurred even at long-term follow-up. 6 Interestingly, 40 years later, the Hufnagel principle was revitalized by Cale et al 11 who reported 4 patients with malfunction of biological prostheses following aortic valve replacement who were considered at extremely high risk for reoperation or even inoperable; in all of them a mechanical prosthesis was implanted into the thoracic aorta with clinical improvement up to 6 years postoperatively.…”

The 70thanniversary of the first artificial heart valve “From a Plastic Valve to Homotransplantation to Cusp Type Valves”

“…It is amazing that this same approach was used almost 40 years later by Cale and colleagues to treat four high operative risk patients with failed aortic bioprostheses. 4 Hufnagel described later his approach for aortic regurgitation (AR) in his article "the direct approach for the correction of aortic insufficiency" that was published in 1961, where he discussed the different etiologies of AR, types of aortic valvular lesions, and different methods of reconstruction and replacement of the native AV. 5 In this fascinating article, he described different surgical techniques for AR, such as the use of homograft "homotransplantation of the aortic valve," placing his plastic valve via ventriculo-aortic anastomotic technique, and the development of different cusp type valves to replace the native AV in the subcoronary position whether partially or totally.…”

“…His implantation of this first “aortic assist” device in a 30‐year‐old woman who had rheumatic fever resulted in severely damaged aortic valve (AV), gave this patient a chance of survival for almost a decade later and she died of unrelated cause. It is amazing that this same approach was used almost 40 years later by Cale and colleagues to treat four high operative risk patients with failed aortic bioprostheses 4 …”