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The history
of cardiopulmonary bypass (CPB) goes back to the 19th
century when LeGallois1
suggested that artificial perfusion of a body part,
isolated from the heart, might preserve its function.
Von Frey and Gruber2
later described the artificial extrapulmonary oxygenation
of blood. In 1929, Brukhonenko3
demonstrated successful total body perfusion after
removal of animal hearts. The development of CPB was
dependent on the number of new, and at the time, revolutionary
discoveries such as blood groups, positive pressure
ventilation, cardiac catheterization, radiological
contrast solution, identification of heparin and protamine
and implementation of roller pump as well as many
other findings in physiology and surgery.
In the span of 20 years, John H. Gibbon, Jr., M.D.,
and others refined the technology of CPB. Dr. Gibbon’s
idea of coupling extracorporeal circulation and oxygenation
to establish temporary, artificially supported circulation
was inspired by a patient with a pulmonary embolism.
The use of CPB for correction of congenital heart
diseases in children began in 1951. It was, however,
a tumultuous start. The first 17 patients died (11
in the operating room).
Dr. Gibbon, while at the Thomas Jefferson Hospital
in Philadelphia, reached a milestone on May 20, 1953.
On that day, he successfully closed an atrial septal
defect in a young woman named Celia Bavolek. Unfortunately,
Dr. Gibbon was unable to repeat his success, and after
operating on an additional four patients, all of whom
died, he gave up his pursuit of CPB. Dr. Gibbon4
is considered the “father” of CPB for
this contribution to the field of extracorporeal circulation.
A year later, C. Walton Lillehei, M.D.,5
at the University of Minnesota-Minneapolis, began
a series of open-heart operations on children using
“controlled cross circulation,” which
utilized an adult as a biologic pump oxygenator.
In 1955, John W. Kirklin, M.D.,6
at the Mayo Clinic in Rochester, Minnesota, began
the first successful series of open-heart surgeries
utilizing an extracorporeal circulation machine (a
modified Mayo-Gibbon-IBM pump oxygenator). He organized
the first team of physicians involved in preparation
of the patient, operative procedure with general anesthesia
utilizing CPB and postoperative care. One member of
the team was an anesthesiologist Robert T. Patrick,
M.D.
Rapid growth of congenital cardiac surgery and increasing
applications of CPB techniques in adults required
more physician training and specialization in the
treatment of cardiac patients.
Anesthesiologists became important members of the
“cardiac team.” Cardiac anesthesiologists
initially formed the Association of Cardiac Anesthesiologists
in 1972. The Society of Cardiovascular Anesthesiologists
was founded in 1978, and its current membership is
more than 7,000.
In 1986, Joel A. Kaplan, M.D., started and continues
as editor of The Journal of Cardiothoracic and
Vascular Anesthesia, which is published six times
a year.
In summary, CPB technology has been an important tool
in the remarkable development of all aspects of cardiovascular
surgery, cardiac anesthesiology, cardiac intensive
care medicine and perfusion technology.
| References: |
| 1. LeGallois JJC, Nancrede NC, Nancrede JC,
trans. Experiments on the Principles of
Life. M. Thomas; 1813. |
| 2. von Frey M, Gruber M. Untersuchungen über
den Stoff-wechsel isolierter Organe. Ein Respirations-Apparat
für isolierte Organe. Virchow’s
Arch Physiol. 1885; 9:519-532. |
| 3. Brukhonenko S. Circulation artificielle
du sang dans l’organisme entier d’un
chien avec coeur exclu. J Physiol Path Gen.
1929; 27:257-272. |
| 4. Gibbon JH Jr, Dobell AR, Voigt GB, et al.
The closure of interventicular septal defects
on dogs during open cardiotomy with the maintenance
of the cardio-respiratory functions by a pump
oxygenator. J Thorac Surg. 1954; 28:235-240. |
| 5. Lillehei CW. Controlled cross circulation
for direct-vision intracardiac surgery; correction
of ventricular septal defects, atrioventricularis
communis and tetralogy of Fallot. Post Grad
Med. 1955; 17:388-396. |
| 6. Kirklin JW, Dushane JW, Wood EH, et al.
Intracardiac surgery with the aid of a mechanical
pump-oxygenator system (Gibbon-type). Report
of eight cases. Proc Mayo Clin. 1955;
30-201-206. |
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Ram Roth, M.D., is Instructor, Department of
Anesthesiology, Mount Sinai School of Medicine,
and Clinical Assistant Attending, Department
of Anesthesiology, Mount Sinai Hospital, New
York, New York. |
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George Silvay, M.D., Ph.D., is Professor, Department
of Anesthesiology, Mount Sinai School of Medicine,
New York, New York. |
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