The Caged-Ball Prosthesis 60 Years Later: A Historical Review of a Cardiac Surgery Milestone

Abstract

Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.

Keywords: Aortic valve; biocompatible materials/history; heart valve prosthesis/history; history, 20th century; mitral valve; prosthesis design/history.

Fig. 1

Photograph shows a Harken-Soroff valve with a stainless-steel double cage and silicone ball. Reproduced with permission from the Museum of Medical History, Sierra Sacramento Valley Medical Society and the Bioengineering Department, California State University, Sacramento, California.

Fig. 2

Photograph shows a Starr-Edwards valve, with a Stellite cage and a Silastic ball. Reproduced with permission from the National Museum of American History of the Smithsonian Institute, Washington, DC.

Fig. 3

Photograph shows a Pemco-Cartwright valve, with an incomplete 4-strut cage and a Silastic ball.

Fig. 4

Photograph shows ball variance due to lipid absorption by the ball of a Pemco-Cartwright valve.

Fig. 5

Photograph shows a Magovern-Cromie valve, with a stainless-steel cage, a silicone ball, and a sutureless fixation ring. Reproduced with permission from the National Museum of American History of the Smithsonian Institute, Washington, DC.

Fig. 6

Photograph shows a Smeloff-Cutter valve, with a titanium double open cage and a silicone rubber ball. Reproduced with permission from the National Museum of American History of the Smithsonian Institute, Washington, DC.

Fig. 7

Photograph shows a DeBakey-Surgitool valve, with a titanium cage and a hollow pyrolytic carbon ball. Reproduced with permission from the National Museum of American History of the Smithsonian Institute, Washington, DC.

Fig. 8

Photograph shows a fatal embolism of the ball of a DeBakey-Surgitool valve after cage rupture. On gross examination, the ball was found at the aortic bifurcation.

Fig. 9

Photograph shows a Braunwald-Cutter valve, with an open, Dacron-covered titanium cage and a silicone rubber ball. Reproduced with permission from the Museum of Medical History, Sierra Sacramento Valley Medical Society and the Bioengineering Department, California State University, Sacramento, California.