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Published by Razvan Rotea

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Published by: Razvan Rotea on May 31, 2012
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Cardiopulmonary bypass (CPB

Since the beginning of times people all over the world have had medical problems with the proper functioning of our body’s most important vital organ, that is the heart. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks. Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease. Luckly enough in the 50’s there was discovered a revolutionary operating method called cardiopulmonary bypass. The cardiopulmonary bypass also known as CPB or the heart-lung machine was invented by John Heysham Gibbon after a young patient died because his heart couldn't be operated safely. This machine has five main parts to it: tubing, pumps(roller pump and centrifugal pump), oxygenator, cannulae and cardioplegia. Unfortunately, CPB has various problems.On April 5, 1951 the heart-lung machine was first used by Dr. Clarence Dennis at University of Minnesota Hospital. The patient did not survive because he had an unexpected heart defect. This failed operation was followed by many experiments on dogs. The first properly-working heart-lung machine was made by John Gibbon on May 6, 1953 at Thomas Jefferson Hospital. The first life he saved was of a young person, the same age as the one that had inspired him. The two most important parts in a cardiopulmonary bypass are the pump and the oxygenator which remove oxygen-deprived blood from the body and replace it with oxygen-rich blood in it. Tubing made of silicon rubber or PVC connects components to each other. The oxygenator puts oxygen in blood and removes carbon dyoxide. The heparin-coated blood oxygenator is said to produce less symmetric inflammation and decrease blood clot in CPB circuit. Cannulae removes oxygen deprived blood from patient. A cardioplegia is sewn in the heart to make it stop beating. Cardioplegia also prevents heart tissue from dying. Although this machine is wonderful but not perfect. The primary risks of cardiopulmonary bypass are blood clots and air bubbles that can cause embolism (occlusion of a blood vessel), damage to red blood cells (HEMOLYSIS), and systemic inflammatory response (IMMUNE SYSTEM activation). There is much debate about whether microemboli that slip through filtration can cause damage to the BRAIN and lungs. All in all, for most people the benefits of cardiopulmonary bypass outweigh the potential risks for these usually transitory side effects. Cardiovascular surgeons continue to explore new techniques that reduce or eliminate the need for cardiopulmonary bypass, including MINIMALLY INVASIVE SURGERY and off-pump procedures though these, too, carry risks.

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