Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

Abstract

The development of cardiopulmonary bypass (CPB) and open heart surgery in the 1950s has benefited millions of people around the world over the last half century. However, it has been recognized since the beginning that there are detrimental effects to CPB. In an effort to minimize the effects of CPB, a miniaturized CPB (M-CPB) closed circuit system also known as closed circuit extracorporeal circulation (CCECC) has been developed as a strategy. In this review, we will look at the rationale behind the development of the miniaturized cardiopulmonary bypass circuits, the published results in comparison to both conventional CPB (C-CPB), and off pump Coronary Artery Bypass Grafting (OPCAB), and the surgical and perfusion strategies to incorporate this technique into everyday adult cardiac surgical practice. The deleterious effects of CPB have been well described including complement and white blood cell activation with a systemic inflammatory response resulting in renal, hematologic, pulmonary, and neurologic effects [1]. The inflammatory response is partially explained by blood contact with the artificial surface of the bypass circuit [2]. There are disturbances in the coagulation cascade which contribute to the need for transfusion of blood products. Post operative atrial fibrillation, one of the most common complications after cardiac surgery, is thought to be related to CPB [3]. M-CPB reduces the artificial surface for blood contact with less of a resulting inflammatory reaction [4].