Cardiopulmonary Bypass: The Historical Foundation, the Future Promise

Abstract

Cardiopulmonary bypass (CPB) is used so routinely in hospitals around the world that most of the participantssurgeons, anesthesiologists, perfusionists, operating room nurses and, above all, patients -forget that this landmark in clinical technology is not even 40 years old. In fact, many of the pioneers are still active in the field. Yet, so much has been done to transform a once-hazardous procedure into standard medical practice-through basic science, quality control, and good manufacturing-that one hardly remembers the days (not so long ago) when "pump-oxygenators," as they were graphically called, were assembled just outside the operating room by tinkerers with a dream. The purpose of this chapter is to recall the inventiveness displayed by a small coterie of gifted investigators to whom we owe the mechanical and physiologic foundations of open-heart surgery, and to reflect on the new demands that continuing clinical advances will undoubtedly make on this technology.

The history of extracorporeal oxygenators*

“…The use of oxygenators during the early years of open-heart surgery The Mayo-Gibbon pump-oxygenator The painstaking work of Gibbon in designing experimental film oxygenators that had extended over two decades [21][22][23][24][25] was crowned with success when he carried out the first successful human intracardiac operation under direct vision using a mechanical extracorporeal pump-oxygenator on 18th May 1953 [2,10,22,25]. Gibbon's original objective was to develop an apparatus capable of suspending the natural circulation during Trendelenburg's emergency operation for pulmonary artery embolectomy [21,22].…”

“…Gibbon's original objective was to develop an apparatus capable of suspending the natural circulation during Trendelenburg's emergency operation for pulmonary artery embolectomy [21,22]. However, the first human operation was in fact closure of an atrial septal defect [25].…”

“…However, the first human operation was in fact closure of an atrial septal defect [25]. Gibbon's early experimental oxygenator filmed blood over the inner surface of a rotating cylinder in an oxygen atmosphere [2,[21][22][23]. However, this could not be enlarged to perfuse animals larger than a cat [28].…”

“…It gave good service in the early days of clinical cardiopulmonary perfusion, but it was cumbersome and required considerable time and expertise to service and assemble. Later, simpler versions with Teflon Ò -coated stainless steel discs in a silicone-coated Pyrex Ò chamber were preferred [6,10,22,[34][35][36]. Some disc oxygenators with presterilised disposable plastic discs became available later [6].…”

“…This led to risks of foaming and haemolysis when the discs spun, which limited their clinical applicability [22,33]. Nevertheless, rotating disk oxygenators continued to be favoured by many clinicians in the 1960s and 1970s despite the dominance of the practical disposable singleuse disposable bubble oxygenators until single-use membrane oxygenators became generally available.…”