ABSTRACT
In the 1920s, Brukhonenko was the first to advance the concept of total body perfusion with removal of the heart.1 However, the development of a true heart-lung machine could not be fully explored until the emergence of new scientific knowledge, such as blood com patibility, identification of a reliable anticoagulant (heparin) and anticoagulant antagonist (prota mine), the establishment of metabolic needs during hypothermia and implementation of the roller pump.2 Inspired by the tragic death of a young gravid woman sustaining a massive pul monary embolus, Dr. John Gibbon Jr was the first to suggest coupling the extracorporeal circulation with an oxygenator to conduct cardiac surgery procedures.3 Through constant re finement of his heart-lung machine model over almost two decades, Dr. Gibbon successfully performed an atrial septal defect closure in a young woman in May 1953, using total extracor poreal circulation.4 Such a pioneering contributive association with the works of others, such as Lillehei on the cross-circulation, Bigelow on deep hypothermia and Melrose on myocardial protection, prompted a new era in the surgical management of cardiac disorders.5”7
Since its clinical application, cardiopulmonary bypass (CPB) has evolved tremendously through a collaborative effort of physiologists, pharmacologists, engineers and physicians. The bulky, cumbersome, “stationary film oxygenator” of the Gibbon-Mayo-IBM pump was aban doned for the more sophisticated and efficient bubble oxygenators. The roller pump coupled with large-bore flexible tubings established itself as the optimal blood-pumping system. The explosion of coronary artery bypass surgery in the 1970s led to the industrial production of membrane oxygenators through major advances in material science and device technology. During the 1980s, recognition of the deleterious effects of CPB focused efforts on developing more biocompatible surfaces, such as heparin coating of the extracorporeal circuit surfaces. Within three decades, the heart-lung machine transformed itself from an artisanal hand-made unit to an effective, reliable, large-scale mass-production system, allowing complex and lengthy cardiac surgical procedures to be undertaken.
