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