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Minimized extracorporeal circulation (MECC) is a kind of cardiopulmonary bypass (heart-lung machine), a part of heart surgery. [1] The introduction of extracorporeal circulation has facilitated open heart surgery. The development of modern techniques in extracorporeal circulation is the result of the combined efforts of physiologists, physicians, and engineers. During the first half of the 20th century scientists refined their methods in the development of extracorporeal circulation so that it could be used in humans.
In 1937 Gibbon reports the first successful use of extracorporeal circulation in animals (in this case, cats). On May 6, 1953 Gibbon performed his first successful operation using an extracorporeal circuit in an 18-year-old woman who had a large atrial septum defect with a large left-to-right shunt. It was Lillehei who one year later introduced the bubble oxygenator, simple and inexpensive, opening the doors of open heart surgery to all surgeons around the world.
The first commercial minimized extracorporeal circulation was the CorX System from Cardiovention, a start-up company from the USA. This system included an integrated centrifugal pump – polypropylene oxygenator, a complete heparin-coated surface and a low priming volume. One of the most effective Mini-Systems (MECC Maquet) was introduced almost at the same time (1999). The increasing application in clinical practice explains this machine's success. The benefits of this type of extracorporeal circulation are that a lower consumption of blood and blood products is observed in the peri-operative and post-operative phase and that a lower inflammatory response is being measured in peri-operative blood samples in comparison to conventional cardiopulmonary bypass.
Coronary artery bypass surgery, also known as coronary artery bypass graft is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment.
Experiments in the Revival of Organisms is a 1940 motion picture directed by David Yashin which documents Soviet research into the resuscitation of clinically dead organisms.
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation. The device used is a membrane oxygenator, also known as an artificial lung.
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease ; to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.
A cardiovascular perfusionist, clinical perfusionist or perfusiologist, and occasionally a cardiopulmonary bypass doctor or clinical perfusion scientist, is a healthcare professional who operates the cardiopulmonary bypass machine during cardiac surgery and other surgeries that require cardiopulmonary bypass to manage the patient's physiological status. As a member of the cardiovascular surgical team, the perfusionist also known as the clinical perfusionist helps maintain blood flow to the body's tissues as well as regulate levels of oxygen and carbon dioxide in the blood, using a heart–lung machine.
An extracorporeal is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surgery.
Arterial switch operation (ASO) or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA).
A membrane oxygenator is a device used to add oxygen to, and remove carbon dioxide from the blood. It can be used in two principal modes: to imitate the function of the lungs in cardiopulmonary bypass (CPB), and to oxygenate blood in longer term life support, termed extracorporeal membrane oxygenation (ECMO). A membrane oxygenator consists of a thin gas-permeable membrane separating the blood and gas flows in the CPB circuit; oxygen diffuses from the gas side into the blood, and carbon dioxide diffuses from the blood into the gas for disposal.
John Webster Kirklin was an American cardiothoracic surgeon, general surgeon, prolific author and medical educator who is best remembered for refining John Gibbon's heart–lung bypass machine via a pump-oxygenator to make feasible under direct vision, routine open-heart surgery and repairs of some congenital heart defects. The success of these operations was combined with his other advances, including teamwork and developments in establishing the correct diagnosis before surgery and progress in computerized intensive care unit monitoring after open heart surgery.
An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or great blood vessel. These organs can be the heart, lungs or liver, while the great vessels can be the aorta, pulmonary artery, pulmonary veins or vena cava.
Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass as a treatment for coronary heart disease. It was primarily developed in the early 1990s by Dr. Amano Atsushi. Historically, during bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB, the heart is still beating while the graft attachments are made to bypass a blockage.
The bidirectional Glenn (BDG) shunt, or bidirectional cavopulmonary anastomosis, is a surgical technique used in pediatric cardiac surgery procedure used to temporarily improve blood oxygenation for patients with a congenital cardiac defect resulting in a single functional ventricle. Creation of a bidirectional shunt reduces the amount of blood volume that the heart needs to pump at the time of surgical repair with the Fontan procedure.
Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.
The Senning procedure is an atrial switch heart operation performed to treat transposition of the great arteries. It is named after its inventor, the Swedish cardiac surgeon Åke Senning (1915–2000), also known for implanting the first permanent cardiac pacemaker in 1958.
Clarence Dennis was an American cardiothoracic surgeon best known for his work in pioneering cardiopulmonary bypass (CPB). He had invented one of the first heart-lung bypass machines, and in 1951 he became the first to use such a device during an open-heart operation.
Extracorporeal cardiopulmonary resuscitation is a method of cardiopulmonary resuscitation (CPR) that passes the patient's blood through a machine in a process to oxygenate the blood supply. A portable extracorporeal membrane oxygenation (ECMO) device is used as an adjunct to standard CPR. A patient who is deemed to be in cardiac arrest refractory to CPR has percutaneous catheters inserted into the femoral vein and artery. Theoretically, the application of ECPR allows for the return of cerebral perfusion in a more sustainable manner than with external compressions alone. By attaching an ECMO device to a person who has acutely undergone cardiovascular collapse, practitioners can maintain end-organ perfusion whilst assessing the potential reversal of causal pathology, with the goal of improving long-term survival and neurological outcomes.
Richard A. DeWall (1926-2016), was an American cardiothoracic surgeon who in 1955 created the first workable, portable bubble oxygenator that removed bubbles, thus avoiding gas embolism during cardiopulmonary bypass. Later, he wrote the original plans for what became the Wright State University School of Medicine.
Retrograde autologous priming (RAP) is a means to effectively and safely restrict the hemodilution caused by the direct homologous blood transfusion and reduce the blood transfusion requirements during cardiac surgery. It is also generally considered a blood conservation method used in most patients during the cardiopulmonary bypass (CPB). The processing of RAP includes three main steps, and the entire procedure of RAP could be completed within 5 to 8 minutes. This technique is proposed by Panico in 1960 for the first time and restated by Rosengart in 1998 to eliminate or reduce the risk of hemodilution during CPB. Moreover, to precisely determine the clinical efficacy of RAP, many related studies were conducted. Most results of researches indicate that RAP is available to provide some benefits to reducing the requirements for red blood cell transfusion. However, there are still some studies showing a failure of RAP to limit the hemodilution after the open heart operation.