History of cardiopulmonary bypass
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History of cardiopulmonary bypass
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History of cardiopulmonary bypass
- 1. History of Cardiopulmonary bypass • The first operation performed using cardiopulmonary bypass and open cardiotomy was on April 5, 1951 by Dr.Clarence Dennis at the University of Minnesota. This was following four years of experiments with dogs
- 2. History of Cardiopulmonary Bypass • The first successful open heart procedure on a human using bypass machine was performed by John Gibbon on May 6, 1953 in Philadelphia. The operation was correction of an ASD on an 18 years old girl.
- 3. History of Cardiopulmonary Bypass • Dr. F. John Lewis , after a period of laboratory research on dogs successfully closed a secundum atrial septal defect ( ASD) in a 5 years old girl under direct vision using inflow stasis & moderate body hypothermia .
- 4. Controlled cross circulation • an experimental technique in which the large blood vessels of two animals, for example, dogs, are joined so as to create a common circulatory system. • The first cross circulation experiment was performed in 1890 by the Belgian physiologist L. Frederic, who joined the carotid arteries of two dogs. The method was subsequently widely used by the Belgian pharmacologist C. Heymans. The method is used in organ and tissue transplantation, chiefly to equalize the immunological systems of the donor and recipient, and in some procedures that involve the heart and major blood vessels of higher, warm-blooded animals.
- 5. Cross circulation • Cross circulation is achieved by suturing major arteries, such as the carotid or femoral of partners and their corresponding veins. To avoid excess pumping of blood from the organism with a high arterial pressure to that with a low one, the Soviet physiologist V. P. Demikhov proposed that only the heart of one partner be allowed to function in the joint circulatory system. The method has been improved to allow experiments to continue for several days, thus broadening the applicability of cross circulation in experimental biology and medicine.
- 6. • Controlled refers to the use of pump ( sigmamotor) to control the balance of fluid into and out of donar and patient . • The “azygos flow concept” led to the first clinical use of controlled cross-circulation for closure of VSD on March 26, 1954, by Dr. C. Walton Lillehei. He was the first surgeon to successfully close a ventricular septal defect, the first to do a total repair of tetralogy of Fallot, and the first to repair a persistent common atrioventricular canal. He did 45 operations using cross circulation and had 28 survivors in 1954-1955.
- 7. Azygous flow Technique • A principal based on the observation that animals can survive prolonged vena caval occlusion without sequelae if blood from the azygos vein alone is permitted to enter the heart, patients • are reperfused during cardiac and pulmonary bypass at flows much less than the normal resting cardiac output • This is the low flow principle via azygous vein
- 8. • On the other hand ,De Wall Lillehei developed Bubble oxygenator in 1955 initially it failed due to air embolism,but De Wall Lillehei did large number of cases both on adult & children using the same oxygenator with less mortality, Gott et al developed self contained unitized plastic sheet oxygenator in 1956. In 1966 De Wall developed hard shell bubble oxygenator integrated with heat exchanger which was disposable,pre- sterilized,polycabonate unit
- 9. Bubble oxygenator Have a direct gas to blood interface, thus causing contact and complement pathway activation leading to activation of C3 and C5A; pulmonary and myocardial edema
- 10. • Heterologous biologic oxygenators( 1955 ) : some experiments had done using pair of canine lungs, monkeys lungs as oxygenators in university of Minnesota. • Mechanical pump oxygenators for CPB: In the beginning Era Gibbon type screen pump oxygenator developed in Mayo clinic,1st clinical application was on March 22, 1955, this was successful with declined mortality. Koff et al in 1956 described disposable membrane oxygenator Clowers & Neville described their clinical studies with membrane oxygenator & they considered that is suitable in 1958. Membrane oxygenator was associated with less reduction of platelets, less complement activation, less haemolysis,fewer micro emboli In longer surgery membrane oxygenator was effective than bubble oxygenator or film oxygenator,further Hollow fiber membrane oxygenator invented with venous reservior,cardiotomy suction chambers, low priming volumes, efficient gas transfer & integrated with heat exchanger
- 11. • In 1954, there were only one place in the world doing open heart surgery which was university of Minnesota Hospital in Minneapolis using cross circulation technique • In 1955 – 1956, there were two places Minnesota & other was Mayo clinic little apart from each other • In Mayo clinic they were using Gibbon apparatus ( screen oxygenator) which was very expensive ,very impressive in appreance but very difficult to use & maintain, on the other hand De Wall’s bubble oxygenator€ which was simple one, disposable, heat sterilized & cheaper.
- 12. THANK YOU