Advent Of Cardiopulmonary Bypass Research Articles

Acute Massive and Submassive Pulmonary Embolism: Historical Considerations/Surgical Techniques of Pulmonary Embolectomy/Novel Applications in Donor Lungs with Pulmonary Emboli.

Pulmonary embolectomy has a chequered history but the quest to surgically treat a patient diagnosed with pulmonary embolism effectively spurred the development of cardiopulmonary bypass and a new dawn for cardiac surgery. The advent of cardiopulmonary bypass, extracorporeal membrane oxygenation, and computed tomography pulmonary angiogram has allowed rapid diagnosis and made surgical pulmonary embolectomy a relatively safe procedure that should be considered when indicated. Pulmonary emboli in donor lungs, often get rejected for transplantation. Ex vivo lung perfusion is among newly available technology with the ability to not only recondition marginal lungs but also treat donor lung pulmonary embolisms, effectively increasing the donor pool.

Cardiac Tumors: Echocardiographic Diagnosis and Forensic Correlations.

In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.

Embolization of the internal thoracic arteries in refractory angina

Embolization of the internal thoracic arteries in refractory angina

Dawn and evolution of cardiac procedures before the advent of cardiopulmonary bypass

Dawn and evolution of cardiac procedures before the advent of cardiopulmonary bypass

Successful Management of Membrane Oxygenator Failure during Cardiopulmonary Bypass—The Importance of Safety Algorithm and Simulation Drills

With a high risk to time ratio, the advent of cardiopulmonary bypass has facilitated greater advances in technical procedures in cardiac surgery. This, however, has not come without its own complication risk and previous near misses have been reported with regard to various technical aspects of the cardiopulmonary bypass circuit. We present a case of a failed membrane oxygenator and discuss the real-life aspects to managing this complication without added risk to the patient.

Mechanical Circulatory Support for Advanced Heart Failure

Both acute and chronic systolic heart failure can progress to an advanced phase, resulting in stage D heart failure and even cardiogenic shock. Despite significant progress in the treatment of systolic heart failure using medical and device therapies, this terminal phase continues to be prevalent and associated with unacceptably high morbidity and mortality. Given the inability to offer cardiac transplantation to the majority of those presenting with advanced heart failure, alternative strategies for cardiac replacement therapy are often required. Although there has been interest in using mechanical devices to support the circulation since the advent of cardiopulmonary bypass, it is only in the past 20years that ventricular assist devices (VAD) have become viable options for therapy. Indeed, we are now entering an era where circulatory assist devices are being used not only to temporarily support patients with post-cardiotomy shock, but also as a long-term treatment in ambulatory heart failure patients. Furthermore, we are now able to utilize data from multicenter trials and registries to guide treatment decisions. These data have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure (bridge to recovery and bridge to transplant) or as long-term support (destination therapy). However, with a growing heart failure population there is much work to be done to improve VAD technology, patient selection, post-implantation management, and to define the optimal role for assist devices in the management of systolic heart failure. We are also in the nascent stages of fully understanding the impact of mechanical support on the failing myocardium, and developing research methodologies to study novel therapies in tandem with VADs to facilitate ventricular recovery. These important questions are currently being addressed in ongoing clinical trials, registry analyses, and translational research endeavors.

Cardiopulmonary bypass as an adjunct for the noncardiac surgeon

The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.

Editorial

Congenital heart disease is frequently encountered by the physician caring for children. Diagnosis is typically made shortly after birth when dynamic changes in circulatory status occur. With prenatal screening, fetal diagnosis of cardiac disease is becoming much more common. Infrequently, an infant or child will present at a later age with occult congenital heart disease. Surgical treatment of congenital heart disease has improved markedly since the advent of cardiopulmonary bypass in 1953; mortality of repair is now less than 5% for all categories combined. Although the spectrum of defects can be morphologically classified into 37 individually recognized categories, many can be subclassified into groups which share similar clinical presentation and management. In this chapter, general considerations are discussed with a focus on issues germane to the pediatric general surgeon encountering these patients. Special consideration is given to single ventricle patients who represent an increasingly common and high-risk group, and who require complex and paradoxical management strategies.

Neuroprotective effects and mechanisms of fentanyl preconditioning against brain ischemia

Fentanyl is an artificial agonist of opioids, and belongs to the μ-opioid receptor agonists. During cardiopulmonary bypass (CPB), a large dose of fentanyl was administered (usually achieved 50–100 μg/kg, loading dose exceeded 50 μg/kg, maintenance dose was 20–30 μg/min). Since the advent of CPB, cerebral complications from overt stroke to subtle cognitive dysfunction after CPB for cardiac surgery have been well documented; the postoperative incidence of dysfunction of cognition exceeded 20–70%. The etiology of these injuries are probably associated with cerebral microemboli, global or regional ischemia, inflammation, cerebral temperature modulation and metabolic abnormality. There are disputes about the effects of large doses of μ-opioid receptor agonist; furthermore, evidence about the effect of large doses of fentanyl on brain injury during CPB have not been reported. Some researchers documented that μ-opioid receptor agonists (including morphine or fentanyl) had neuroprotective effects, and predominantly by the activation of δ1 opioid agonist. While reports that μ-opioid receptor agonists have no neuroprotective effect, even causing brain injury can also been seen.

Percutaneous Valve Procedures – a surgeon’s Viewpoint

‘Just as stents have broadened the spectrum of care for coronary disease, so will percutaneous approaches to treat valve disease.’ The next great challenge in interventional cardiac care is the development of transvascular approaches to treat valvular pathology. In 1960, the first successful intracardiac valve replacements were performed by Harkin (aortic) [1], Braunwald (mitral) [2] and Starr (mitral) [3]. This was made possible by the invention of cardiopulmonary bypass, enabling cardiac isolation and safe entry into the cardiac chambers. Prior to the era of cardiopulmonary bypass, other approaches to treat valvular heart disease were explored, including the placement of a prosthesis in the descending aorta to treat aortic insufficiency and manual mitral commissurotomy on the beating heart. Given markedly better outcomes, most of these techniques were supplanted by the intracardiac approach with the advent of cardiopulmonary bypass.

Advances in congenital heart surgery.

Congenital heart surgery is a young and constantly evolving field. Since the first patent ductus arteriosus ligation by Robert Gross of Boston in 1938, a greater understanding of the anatomy and pathophysiology of congenital heart disease, improved diagnostics, and the advent of cardiopulmonary bypass and deep hypothermic circulatory arrest have allowed the open repair of many lesions. Further advances in preoperative, intraoperative, and postoperative patient management have resulted in greatly improved survivals for even the most complex congenital defects. By looking forward through continual technical innovation and back with the critical evaluation of established techniques, we continue to advance the care of the patient with congenital heart disease.

Current status of MIDCAB procedure.

The advent of cardiopulmonary bypass in the early 1960s allowed surgeons to safely perform complex reconstructions on the heart. Since then, the field of cardiac surgery has progressed to where surgical myocardial revascularization, or coronary artery bypass grafting (CABG), has become the most exhaustively studied operation in the history of surgery, and it has achieved widespread use because its benefits have been so thoroughly documented. The paradoxical fact is that more elderly and debilitated patients benefit the most from cardiac surgery compared with medical therapy, yet they sustain greater risk of morbidity and mortality after cardiac surgery. Most of the recent innovations and refinements in the treatment of coronary artery disease aim toward reduction of trauma without deviating much from the safety and efficacy of the conventional procedures. As a consequence, a greater number of high-risk elderly patients have become candidates for coronary artery bypass grafting (CABG). All of the amendments are caused by changing clinical scenarios brought on by an increased number of aging patients, a greater number of patients requiring re-operations, cost containment, increased discernment about outcome assessment, and also the dominance of coronary bypass being threatened by the success of interventional cardiology.

European approach to cardiopulmonary bypass in neonates

The advent of cardiopulmonary bypass in 1953, and its subsequent continuous refinements, have securely established the specialty of cardiovascular surgery. In conjunction with the improved methods of myocardial preservation, this has allowed the safe repair of acquired and complex congenital cardiac defects. During the years, the many variables of the systems used for cardiopulmonary bypass have been altered to the point that most operations are now reproducible with, relatively, low morbidity and mortality. Although in its present form the system is quite reasonable for most routine surgery, it is far from perfect. There remains, therefore, a quest for alterations to improve the system as an ongoing process. Certain complications of open-heart surgery persist and many new and unique approaches to the concept of organ protection and the treatment of these complications must be developed and refined.