Direct-vision aortic valvotomy: predecessor to modern aortic surgery.

In 1956, Swan and Kortz described a direct-vision aortic valvotomy performed through a transaortic approach during caval occlusion and moderate hypothermia. The rationale for this approach was based on careful thought and review of relevant information that was available at that time. Although cardiopulmonary bypass has since supplanted inflow occlusion to enable exposure of the aortic valve during operation, the principles considered by Swan and Kortz have survived decades of change. Their contribution heralded the beginning of modern aortic surgery while demonstrating the carefulness of thought supported by the audaciousness of conviction that characterizes innovation in surgery.