scholarly journals Development of cardiopulmonary bypass: A historical review

2016 ◽  
Vol 144 (11-12) ◽  
pp. 670-675 ◽  
Author(s):  
Stamenko Susak ◽  
Aleksandar Redzek ◽  
Milenko Rosic ◽  
Lazar Velicki ◽  
Bogdan Okiljevic
Keyword(s):  
Cardiopulmonary Bypass ◽  
Extracorporeal Circulation ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Historical Review ◽  
Organ Perfusion ◽  
Cardiac Pathology ◽  
Isolated Organ Perfusion ◽  
Cardiac Surgeons ◽  
Right Heart Bypass

The idea of isolated organ perfusion, a precursor of cardiopulmonary bypass, came by Legalois in 1812. First isolated organ perfusion was described by Loebell in 1849. The first closed system for oxygenation and returning the blood through arteries was created by Frey and Gruber in 1885. Gibbon Jr. is considered the father of extracorporeal circulation. In spring of 1934 he began constructing a machine for extracorporeal circulation in Boston. He published the first description of this system in 1937. Gibbon won the grant of the International Business Machines Corporation for developing the machine in 1947. Together they developed Model I in 1949 and Model II in 1951. After a few unsuccessful attempts in 1952, the first successful surgical intervention on the heart (closure of atrial septal defect) using cardiopulmonary bypass was performed on May 6, 1953. In 1945, Kirklin and his working group reported on a series of eight successfully treated patients in a row who underwent surgery with extracorporeal circulation. First successful valve surgery under the direct vision was performed by Dodrill in 1952, using his ?Michigan Heart? machine as a right heart bypass. Using cardiopulmonary bypass, cardiac surgeons can deal with the complex cardiac pathology and save millions of lives.

scholarly journals Effect of Patient Age at Surgical Intervention on Long-Term Right Ventricular Performance in Atrial Septal Defect

2004 ◽  
Vol 45 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Seden Celik ◽  
Batuhan Ozay ◽  
BahadIr Dagdeviren ◽  
Sevket Gorgulu ◽  
Aydin Yildirim ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Patient Age ◽  
Ventricular Performance ◽  
Patient Âgé ◽  
Right Ventricular Performance

scholarly journals Results of observation of the postoperative period in patients with surgical aortic pathology after surgical intervention using cardiopulmonary bypass

2019 ◽  
Vol 23 (2) ◽  
pp. 267-276
Author(s):  
K. A. Khyzhniak ◽  
Y. V. Volkova ◽  
K. Y. Sharlai ◽  
M. V. Khartanovych
Keyword(s):  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Infusion Therapy ◽  
The Third ◽  
Group I ◽  
Aortic Pathology ◽  
Number Of Patients ◽  
Group Ii

The aim of the work was to analyze the results of the observation of the postoperative period in patients with surgical aortic pathology after surgical intervention using cardiopulmonary bypass. 118 patients with surgical aortic pathology (SAP) were examined. Patients were divided into 2 groups. Group I included 46 patients who were additionally prescribed a solution of meglumin sodium succinate (reamberin), group II included 46 patients who were additionally assigned a solution of D-fructose-1,6-diphosphate sodium hydrate salt (esophosphine). The control group (K) consisted of 26 patients who had surgical pathology of the aorta, all the criteria coincided with patients of groups I and II, but did not have additional substances as part of intensive care (IT) in order to prevent postoperative cognitive dysfunction (PСD). Analyzed the patient's condition on a scale of postoperative mortality prediction EuroSCORE II, the depth of anesthesia with a BIS monitor, the qualitative composition of the leukocyte formula, nasal and rectal temperature, blood gas composition, electrolyte level, glucose, lactate, coagulogram indices, hemolysis and phosphates; levels of autoantibodies to brain antigens (MBP, calcium binding protein S-100, NSE and GBA) were determined in the serum by ELISA a day before the operation and on the first, third, seventh and fourteenth day after surgery. The morphometric and functional properties of erythrocytes were investigated the day before the operation (starting level), 12:00 after the operation, and on the third day of hospital stay. The initial assessment of the cognitive abilities of the patients was made the day before the operation, on the third, seventh and fourteenth day of hospital stay. Used to determine the magnitude of the coefficient of linear Pearson correlation. In the analysis, no significant differences were found between the preliminary data on the phosphorus content in the patients' blood, however, the recovery dynamics of its numbers differed in the K, I and II patients. So, in group K and in group I, after 12:00 after surgery, the level of phosphatemia was 0.86 ± 0.21 mmol/l and 0.85 ± 0.18 mmol / l, on the 3rd day of hospital stay — 0,94 ± 0.08 mmol/l and 0.97 ± 0.04 mmol/l, on the 7th day — 1.04 ± 0.16 mmol/l and 1.07 ± 0.21 mmol/l and on The 14th day — 1.08 ± 0.12 mmol/l and 1.1 ± 0.14 mmol/l. It can be noted that the dynamics of blood phosphatemia in patients of groups K and I was identical, its figures almost coincided in terms of the level of phosphorus in the blood and the corresponding number of patients in the variation rows of patients in both groups. It may be noted that there is an unconditional positive effect on the course of the perioperative period of the option of infusion therapy in the IT complex in patients of group II.  

Abstract 17170: Does Cardiopulmonary Bypass Provide Adequate End-Organ Perfusion?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marijan Koprivanac ◽  
Ahmed Aly ◽  
Jonathan Magruder ◽  
Andrew Acker ◽  
Joshua Grim ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Tissue Perfusion ◽  
Fluid Administration ◽  
Organ Perfusion ◽  
Arterial Ph ◽  
Venous Oxygen Saturation ◽  
Using Data ◽  
Lactate Levels ◽  
Vasopressor Use

Introduction: Our clinical experience in cardiac surgery teaches us that a subset of patients show signs of unexplained end-organ hypoperfusion after an otherwise unremarkable procedure. The objective of this study is to comprehensively examine cardiopulmonary bypass (CPB) management parameters and end-organ perfusion. Hypothesis: Despite advancements in CPB management, CPB does not provide adequate end-organ perfusion. Methods: Retrospective analysis was performed using data from 1462 cardiac operations performed from 2/2019 to 4/2020, excluding circulatory arrest and non-CPB cases. CPB management parameters included cardiac index (CI), mean arterial pressure (MAP), vasopressor-phenylephrine use, lines and bladder temperatures, hemoglobin (Hgb), indexed oxygen delivery (iDO 2 ), and intravenous fluid infusion. End-organ perfusion markers included lactate levels, mixed venous oxygen saturation (SvO 2 ), oxygen consumption (VO 2 ), and arterial pH. Results were expressed as means with first standard deviation. Results: During CPB, CI, MAP, iDO 2 and Hgb were 2.2 ± 0.4 l/min/m 2 , 67 ± 16 mmHg, 270 ± 71 ml/min/m 2 , and 9.3 ± 1.6 g/dl respectively (Figure 1). Phenylephrine cumulative dose increased with CPB duration, 11 ± 9 mg at 1h and 20 ± 15 mg at 2h. Fluid administration showed similar trend. Core mean temperature was maintained with nadir being 33.5 ± 3.4°C. SvO 2 rapidly increased with institution of CPB, peaking at 85%, and then slowly declined. Inversely, VO 2 dropped and then slowly increased. Lactate continuously increased with duration of CPB. Conclusions: Our findings suggest that despite hemodynamic values being maintained at goal by continuously high vasopressor use and fluid administration during CPB, tissue perfusion was inadequate.Our study suggests that, using data-driven approaches, it may be time to revisit the assumptions regarding all aspects of managing CPB.

Air Embolism on Cardiopulmonary Bypass

2019 ◽  
pp. 160-165
Author(s):  
Aaron Hudson ◽  
Ryan Hood
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Sudden Death ◽  
Air Embolism ◽  
Cardiac Surgical Procedures ◽  
Daily Basis ◽  
Team Members ◽  
Cardiac Surgeons ◽  
Almost All

The danger associated with air embolism in cardiac surgery has been well established for over 125 years. In the first volume of Annals of Surgery, published in 1885, long preceding the era of cardiac surgery and the use of extracorporeal circulatory techniques, Dr. Nicholas Senn alluded to the ensuing calamity caused by air embolism: “I intend on this occasion to call your attention to one of the most dreaded and, I may add, one of the most uncontrollable causes of sudden death—I allude to air-embolism.”1,2 Since the advent of modern cardiac surgery, much attention has been focused on the prevention of air embolism by cardiac surgeons, anesthesiologists, and perfusionists alike. Indeed, all three team members are critically responsible for the safe conduct of thousands of cardiac surgical procedures occurring on a daily basis worldwide. While the morbidity and mortality of massive air embolism is exceedingly high, most believe that with appropriate training and unwavering vigilance during clinical practice, almost all massive air emboli can be prevented.3

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 138-144
Author(s):  
Helena Argiriadou ◽  
Polychronis Antonitsis ◽  
Anna Gkiouliava ◽  
Evangelia Papapostolou ◽  
Apostolos Deliopoulos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Correlation Coefficient ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Minimal Invasive ◽  
Elective Cardiac Surgery ◽  
Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience

2020 ◽  
Vol 30 (3) ◽  
pp. 409-412
Author(s):  
Murat Surucu ◽  
İlkay Erdoğan ◽  
Birgül Varan ◽  
Murat Özkan ◽  
N. Kürşad Tokel ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Systolic Pressure ◽  
Presenting Symptoms ◽  
Long Term Follow Up ◽  
The Right

AbstractObjective:Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery.Methods:We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated.Results:Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1).Conclusion:The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.

scholarly journals Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment

Perfusion ◽  
2018 ◽  
Vol 34 (4) ◽  
pp. 297-302
Author(s):  
Anke Dürr ◽  
Andreas Kunert ◽  
Günter Albrecht ◽  
Andreas Liebold ◽  
Markus Hoenicka
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Circulation ◽  
Pulsatile Flow ◽  
Organ Perfusion ◽  
Pressure Data ◽  
High Compliance ◽  
Energy Equivalent ◽  
Silicone Tubing ◽  
Mock Circulation ◽  
Pulsatile Perfusion

Introduction: Pulsatile extracorporeal circulation may improve organ perfusion during cardiac surgery. Some minimally invasive extracorporeal circulation (MiECC) systems allow pulsatile perfusion. The present study investigated the influence of arterial tubing compliance on hemodynamic energy transfer into the patient. Methods: Aortic models with adult human geometry were perfused in a mock circulation. A MiECC system was connected using either high-compliance silicone tubing or standard kit tubing. Energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) were computed from flow and pressure data. Aortic models with physiological and sub-physiological compliance were tested to assess the influence of the pseudo-patient. Results: Non-pulsatile flow did not generate SHE. SHE during pulsatile flow in the compliant aortic model was significantly higher with kit tubing compared to silicone tubing. Maximum SHE was achieved at 1.6 L/min with kit tubing (7.7% of mean arterial pressure) and with silicone tubing (4.9%). Using the low-compliance aortic model, SHE with kit tubing reached a higher maximum of 14.2% at 1.8 L/min compared to silicone tubing (11.8% at 1.5 L/min). Conclusions: Flexible arterial tubing did not preserve more hemodynamic energy from a pulsatile pump compared to standard kit tubing in a model of adult extracorporeal circulation. The pseudo-patient’s compliance significantly affected the properties of the mock circulation.

scholarly journals Human neutrophil degranulation during extracorporeal circulation

Blood ◽  
1987 ◽  
Vol 69 (1) ◽  
pp. 324-330 ◽  
Author(s):  
YT Wachtfogel ◽  
U Kucich ◽  
J Greenplate ◽  
P Gluszko ◽  
W Abrams ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Extracorporeal Circulation ◽  
Neutrophil Elastase ◽  
Membrane Oxygenator ◽  
Protein Marker ◽  
Extracorporeal Membrane Oxygenator ◽  
Bubble Oxygenator ◽  
Neutrophil Degranulation ◽  
Specific Proteins

Abstract Cardiopulmonary bypass, especially when prolonged, may result in hemostatic failure and pulmonary dysfunction, which has been attributed to changes in platelets and leukocytes, respectively. It has been well documented that contact of blood with synthetic surfaces causes platelet activation. In this report, we explore mechanisms of the activation of neutrophils during simulated in vitro extracorporeal circulation and document the release of neutrophil lactoferrin and elastase during clinical cardiopulmonary bypass (CCB). Inhibition in the simulated circuit by prostaglandin E1 (PGE1) and lidocaine suggests different mechanisms for release of neutrophil-specific proteins. During CCB with a bubble oxygenator it was observed that platelet counts fell to 42% +/- 2% of baseline. In addition, beta- thromboglobulin antigen (beta TG), a platelet-specific, alpha-granule protein marker reflecting the release reaction, increased from 0.15 +/- 0.05 to 0.84 +/- 0.11 microgram/mL. Neutrophil counts decreased to 67% +/- 7% of prebypass levels but then gradually rose as bypass continued. Both lactoferrin, a neutrophil-specific granule marker, and neutrophil elastase, an azurophilic granule marker, increased in plasma threefold to 1.66 +/- 0.33 micrograms/mL and 1.65 +/- 0.68 microgram/mL, respectively, just before bypass was stopped. When fresh heparinized human blood was recirculated within an extracorporeal membrane oxygenator bypass circuit for 120 minutes, plasma beta-TG rose to 5.13 micrograms/mL, lactoferrin increased from 0.13 +/- 0.04 to 1.62 +/- 0.22 micrograms/mL, and neutrophil elastase rose from 0.05 +/- 0.02 to 1.86 +/- 0.41 micrograms/mL. At 120 minutes, lidocaine (100 mumol/L), which inhibits neutrophil activation, delayed release of lactoferrin (1.33 +/- 0.26 micrograms/mL) and markedly inhibited release of elastase (0.24 +/- 0.05 microgram/mL) but did not inhibit release of beta-TG antigen (5.66 micrograms/mL at 120 minutes). PGE1 (0.3 mumol/L) inhibited significantly the release of beta-TG (0.31 microgram/mL) and elastase (0.52 +/- 0.11 microgram/mL) and attenuated the release of lactoferrin (1.57 +/- 0.45 micrograms/mL).

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