Old Habits Die Hard

With increasing age, déjà vu experiences seem to become more frequent. Think of transcatheter edge-to-edge repair and the good old Alfieri stitch. Or have a closer look at the anchoring mechanisms of rapid-deployment valves or various TAVI prostheses. It has all been on the scene before.

In the early 1960s, at the very beginning of heart valve surgery, Dr. George Jerome Magovern at the Allegheny Hospital in Pittsburgh, PA, was busy implanting Harken-Soroff and Starr–Edwards ball prostheses, finding them cumbersome at times. Prolonged periods of cardiopulmonary bypass were frequently associated with poor outcomes and in part explain the 20% mortality associated with these procedures. He teamed up with local gifted engineer Harry W. Cromie and together they developed a concept of a two-part circular base for a caged ball valve with a moveable inner cylinder ([Fig. 1]). Rotation of this inner cylinder with a special tool drove fixating metal pins out of the ring into the adjacent aortic wall tissue. This significantly shortened the implantation time compared with conventional suturing.[1] [2]

Fig. 1 Mcgovern–Cromie Aortic Valve, Barium Ball, 1964; public domain. Acknowledgment: https://www.flickr.com/photos/sachistory/7433344022.

Always the entrepreneurs, Magovern and Cromie instantly founded a company, SurgiTools Inc., which produced a variety of heart valve prostheses, including models for Michael DeBakey and Arthur Beall.[3] Its acquisition by Baxter Healthcare in 1968 can also be regarded as something of an early role model for later smaller medical device companies, nowadays known as “startups.” Production of the Magovern–Cromie valve stopped only in 1980 when further refinements in technology and mechanical valve design had changed the environment.

In 1989, Magovern et al published the 25-year experience with his valve.[4] Given the circumstances and its pioneering status, the long-term durability proved to be astonishingly good with low valve-related morbidity. In fact, case reports of functioning valves more than 40 years after implantation further substantiated the durability of this ingenious design.[5] [6]

A true pioneer, George J. Magovern, went on to perform the world's second single-lung transplantation at the University of Pittsburgh in 1963. Always fascinated by technology, he became the first to utilize a left atrial–femoral arterial bypass with a centrifugal pump to prevent spinal cord ischemia during thoracic aortic surgery. His entrepreneurial spirit led to the founding of yet another company, Respironics, in 1976. It developed the first continuous positive airway pressure (CPAP) apparatus for the treatment of obstructive sleep apnea syndrome in 1985. The company was publicly traded in 1988 and, again, was sold in 2007 to a much bigger venture, Royal Philips Electronics Company.[3] In 2021, Philips Respironics made negative headlines with its recall initiative because of the suspected partial disintegration of noise abatement foam in CPAP machines. Fortunately, Dr. Magovern was spared to learn about this, having passed away on November 4, 2013, 2 weeks before his 90th birthday.

Ten years after his death and 60 years after the introduction of the valve prosthesis, the cardiac community is busy still implanting devices following the basic principles described by Magovern and Cromie. It remains to be hoped that their durability will turn out to be similarly good. In the meantime, three things should always be remembered: (1) In valve surgery true longevity is what counts. Whenever you think you have come up with a smart idea, (2) find a congenial partner to complement yourself, and (3) check the history books!

Publication History

Article published online:
30 July 2024

• References

• 1 Magovern GJ, Kent EM, Cromie HW. Sutureless artificial heart valves. Circulation 1963; 27: 784-788
• 2 Magovern GJ, Cromie HW. Sutureless prosthetic heart valves. J Thorac Cardiovasc Surg 1963; 46: 726-736
• 3 Magovern Jr GJ. George Jerome Magovern, MD, November 17, 1923-November 4, 2013. Ann Thorac Surg 2014; 98 (04) 1520-1522
• 4 Magovern GJ, Liebler GA, Park SB, Burkholder JA, Sakert T, Simpson KA. Twenty-five-year review of the Magovern-Cromie sutureless aortic valve. Ann Thorac Surg 1989; 48 (3 Suppl): S33-S34
• 5 Zlotnick AY, Shiran A, Lewis BS, Aravot D. Images in cardiovascular medicine. A perfectly functioning Magovern-Cromie sutureless prosthetic aortic valve 42 years after implantation. Circulation 2008; 117 (01) e1-e2
• 6 Totaro P, Nicolardi S, Zattera G, Viganò M. Old prosthesis with a modern concept: 41-year survival with a sutureless Magovern-Cromie aortic valve prosthesis. Eur J Cardiothorac Surg 2011; 39 (05) 789