Early techniques of extracorporeal circulation.

Abstract

While the techniques and equipment used 50 years ago may seem primitive by today's standards, they did permit cardiac surgery to rapidly develop. As early as 1951, Karlson would write: 'Recent advances in surgery have made operations upon the heart much more than surgical stunts, and have opened a hitherto relatively untouched field of surgical endeavor. A few years later, Mustard would defend his abysmal series of repairs of congenital cardiac defects by saying, 'Our techniques of perfusion and operation have proved feasible in three human cases, but the results are not adequate to operate freely on good-risk patients at the present time. It is hoped that improvements in techniques will soon make this possible'. By the end of the decade of the 1950s. Gross would express the following: In the support of human patients on pump oxygenators, the intricacies of technic are many, and the extent of problems is broad, but much clarity of thought is now evident. We can set forth certain statements considered to represent truths or valuable viewpoints, since in most cases they have derived from scores of laboratory experiences during which some 800 dogs have been used by us, or else they have been crystallized from bitter experience at the operating table, or shattering disappointments in postoperative failures. Fortunately, many of the conclusions have sprung from happy and rewarding results exhibited by patients who have weathered corrective surgery in a very satisfactory manner. In closing, after reviewing the early perfusion literature, it is evident that many techniques used in the 1930s, 1940s, and 1950s persist to the present. Some techniques fell out of favor, such as elective hyperkalemic arrest, only to be re-established decades later. Simplicity is the hallmark of the most enduring techniques, a thought expressed by Lillehei in 1955. Somewhat amazingly, full automation of the extracorporeal circuit existed on some of the very early machines, but perhaps because of the explosive growth of cardiac surgery and the need for disposable circuits that could be rapidly assembled, the safety aspects of heart-lung machines were neglected for many decades. Some would argue it still has not realized its potential for elimination of error in the conduct of cardiopulmonary bypass. However, cardiac surgery would not wait, and in 1956, Osborn would boldly state: 'Extracorporeal circulation for surgery of the heart has now come of age.