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Cardiopulmonary bypass

  • In early 1950s first open heat procedures were performed under
    • Cooling an circulatory arrest
    • Cross circulation between parent and child
    • Cardiopulmonary bypass with pump and oxygenator

Components of cardiopulmonary bypass circuit

Cardiopulmonary bypass circuit
  • Cannula is inserted into right atrium to drain venous return
  • Venous blood passes into venous reservoir under gravity
  • Oxygenated (and CO2) removed usually by membrane oxygenator
  • Heat exchanger control blood temperature
  • Surgery often performed with 5-10 C of hypothermia
  • A 40 mm filter removes air bubbles
  • Pump returns blood into aorta distal to a cross clamp
  • Suction used to remove blood from operative field
  • Returned to patient via cardiotomy reservoir

Cardiopulmonary bypass

Picture provided by Phillip Endelmann, University of Innsbruck Medical School, Austria

Complications of bypass

  • Prolonged bypass induces cytokine activation and an inflammatory response
  • Results in:
    • Red cell damage and haemoglobinuria
    • Thrombocytopenia
    • Clotting abnormalities
    • Reduced pulmonary gas exchange
    • Cerebrovascular accidents


Levy J H,  Tanaka K A.  Inflammatory response to cardiopulmonary bypass.  Ann Thorac Surg 2003;  75:  S715-720.

Merrill W H.  What's new in cardiac surgery.  J Am Coll Surg 2002;  194:  617-635.

Wheatley D J.  Coronary artery surgery at the dawn of the 21st Century.  J R Coll Surg Ed 2002;  47:  608-12.

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