History of Perfusion Brian Schwartz, CCP September 2, 2003 Perfusion I

Introduction Before 1952 Physicians had no means of treating patients with intracardiac malformations With the development of the heart and lung machine, surgeons were able to operate on patients who were once considered “non-operatable”

Historical Time-Line 1952: Lewis performed the first open heart surgery (repair of an ASD). Used inflow occlusion and general hypothermia 1953: Gibbon performed many cases utilizing CPB; yet he only had one success 1954: Lillehei used “cross-circulation” for the closure of a VSD

Historical Time-Line (cont) Late 1950’s: Kirklin used the film oxygenator in a large number of patients May of 1955: The DeWall-Lillehei bubble oxygenator became the method of choice to oxygenate venous blood during open heart surgery Membrane oxygenator developed and used from the 50’s to the 70’s

Historical Time-Line (cont) 1980’s: Design changed with regards to the membrane oxygenator…now microporous, making it the choice of oxygenators Priming the heart and lung machines with non-blood solutions was a major advance in heart sugery Improved tissue perfusion Reduced hemolysis Avoided exposure to donor blood

Reasons Why Initial Results were Discouraging Flow rates were too high Poor visibility Pumping air to patient

Controlled Cross-Circulation for Cardiopulmonary Bypass The thought of using “cross-circulation” for cardiac surgery led to huge debates within the medical community With this method physicians used a “normal human being” to provide donor circulation This technique for ECC was utilized for 45 operations, with no donor mortality/morbidity.