The evolution of cardiopulmonary bypass: lessons to be learned.
John Gibbon conceived cardiopulmonary bypass (CPB) and performed the first intracardiac repair using extracorporeal perfusion in 1953. This achievement stimulated rapid development of the knowledge base and equipment necessary for accurate diagnoses and successful intracardiac operations. In the early 60s increasing evidence indicated that exposure of blood to nonendothelial cell surfaces produced bleeding and thrombotic complications and a massive inflammatory response. Early efforts to discover a synthetic, nonthrombogenic surface gave way to efforts to control the 'whole-body inflammatory response' by pharmacological means. These efforts are ongoing; progress is slow; and heparin is still required for most applications of extracorporeal perfusion technology. Nevertheless, CPB now enables over one million cardiac surgical operations each year. Future progress and the development of artificial internal organs that process blood depend upon control of the blood-surface interface without anticoagulants.
Edmunds
L Henry
LH
Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania, Philadelphia 19104-4283, USA. hedmunds@mail.med.upenn.edu
D001777:Blood Coagulation / Q000187:drug effects; D001798:Blood Proteins / Q000378:metabolism / Q000494:pharmacology; D002309:Cardiology / Q000266:history; D002315:Cardiopulmonary Bypass / Q000266:history* / Q000295:instrumentation; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D010107:Oxygenators, Membrane / Q000266:history; D014481:United States
D001798:Blood Proteins