Cardiopulmonary bypass is a procedure that diverts blood from the heart and lungs through an external heart-lung machine that oxygenates the blood and returns it to the body. This allows surgery to be performed on a motionless and bloodless field within the heart. The goals are to oxygenate and circulate blood while facilitating surgical interventions through systemic cooling and rewarming. Risks increase with longer bypass times and in older or sicker patients, as bypass can affect the heart, brain, kidneys and other organs. The history of bypass began in the 1950s with early techniques using hypothermia and cross-circulation from parents before the development of bubble oxygenators and modern bypass machines.

1. Cardiopulmonary Bypass

2. Content Outline
• History
• Definition
• Cardiopulmonary Bypass goals
• Indications
• Cardiopulmonary Bypass Machine
• Oxygenator
• Cardioplegia Delivery
• Cardiopulmonary Bypass Circulation
• Cardiopulmonary Bypass Physiology
• Risk of Cardiopulmonary Bypass
• Organs affected by Cardiopulmonary Bypass

3. History
• With the advent of vascular techniques and refined tools, quite a few
advances had been made—repair of coarctation, the Blalock-Taussig
shunt for Tetralogy of Fallot, mitral valve fracture and many others.
• September of 1952, Lewis and his colleagues at the University of
Minnesota closed an atrial septal defect on a 5-year-old patient with
Hypothermia and inflow occlusion were the mainstay of operating inside
the heart for a few minutes
• May of 1953 when Dr. John Gibbon corrected an atrial septal defect in a
young woman at Jefferson Hospital in Philadelphia with the assistance of
a true heart-lung machine.

4. History
• In 1955, using some modifications, Dr. John Kirklin operated on a series
of 8 congenital cases with survival of 50%. at the Mayo Clinic.
• Dr. C. Walton Lillehei was developing the technique of "controlled cross-
circulation. This was a method by which a child was connected to his
parent as a "biologic heart machine." Over a 2-year period, Lillehei was
able to operate on 45 children, with 28 surviving. (limitations to this
methodology, as only small children could be supported this way and for
only a short period of time.)
• Soon thereafter, Richard DeWall, from Lillehei's laboratory, developed
the bubble oxygenator. A third type of oxygenator, was developed by
Kay and Cross in Cleveland and was being mass produced.

5. History

6. Definition
Cardiopulmonary bypass is a procedure to
circulate and oxygenate the blood while
surgery is performed on the heart. It
involves diverting blood from the heart and
lungs through a heart/lung machine and
returning oxygenated blood to the aorta.
(AHA Encyclopedia)

7. Cardiopulmonary Bypass Goals
• Oxygination and carbon dioxide elimination
• Circulation of blood
• Systemic cooling and re-warming
• To facilitate a surgical intervention
• Provide a motionless field
• Provide a bloodless field

8. Indications
• Coronary artery Disease
• Congenital Heart Disease
• Valvular Heart Disease
• Vascular Disease (AA,DA)
• Heart Transplant

9. Cardiopulmonary Bypass Machine

10. Oxygenator

11. Cardioplegia Delivery

12. Cardioplegia Delivery

13. Cardiopulmonary Bypass Circulation

14. Cardiopulmonary Bypass Physiology
• Hemodilution
• Anticoagulation
• Hypothermia
• Flow rate & Blood Pressure
• Blood gas Control

15. Risk of Cardiopulmonary Bypass
• Duration of Bypass
• Age
• Cardiac function

16. Organs affected by Cardiopulmonary Bypass
• Heart
• Brain
• Kidneys
• Gastrointestinal tract
• Endocrine systems

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