RESUMO
Midway through the 20th century, direct open-heart operations were not yet a reality, awaiting safe methods to support the cardiopulmonary circulation during cardiac surgery. The scientific advancements collectively leading to safe cardiopulmonary bypass are considered some of the most impactful advances of modern medicine. Stimulated by the work of physiologists and engineers in the late 19th century, primitive pump and oxygenator designs were the forerunners of major work by DeBakey and others in roller pump design and by Gibbon in oxygenator development. Following Gibbon's historic successful closure of an atrial septal defect in 1953 with his heart-lung machine, it was left to Lillehei and Kirklin to first successfully repair large series of cardiac malformations. The history leading to these historic events and the subsequent evolution of cardiopulmonary bypass machines for short- and longer-term support is filled with engineering and surgical brilliance, daring innovations, and serendipity.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Procedimentos Cirúrgicos Cardíacos/história , Ponte Cardiopulmonar , Circulação Extracorpórea , Cardiopatias Congênitas/cirurgia , Máquina Coração-Pulmão/história , História do Século XX , HumanosRESUMO
Bernard J. Miller, MD, ScD. (Hon), FACS, is known as a critical contributor for his work in the John H. Gibbon, MD, laboratory for his work on the heart-lung machine (HLM). In this setting, Dr. Miller developed the fluid control servo system, which was necessary to prevent malfunctioning of the HLM and prevent air emboli. Additionally, Dr. Miller assisted in conceiving and testing the left ventricular vent, the positive-negative pressure ventilator, and the HLM oxygenator; these inventions were all the product of extensive collaboration between the International Business Machines Corporation and the members of Dr. Gibbon's laboratory. Furthermore, Dr. Miller was a surgical assistant and perfusionist in the first successful open-heart surgery. Herein, we seek to describe Dr. Miller's story and his contributions to the HLM, as well as the contributions that were developed by the laboratory at that time. Additionally, we describe critical events leading up to the first successful use of the HLM on May 6, 1953, including a previously unreported use of the HLM for partial bypass of the right heart at Pennsylvania Hospital in 1952. Finally, we present the rest of Dr. Miller's professional and personal successes after his work on the HLM ended.
Assuntos
Cardiologia/história , Máquina Coração-Pulmão/história , Cirurgiões/história , História do Século XX , Humanos , PennsylvaniaRESUMO
In 1962, surgeons at two hospitals in Bombay used heart-lung machines to perform open-heart surgery. The devices that made this work possible had been developed in Minneapolis in 1955 and commercialized by 1957. However, restrictions on currency exchange and foreign imports made it difficult for surgeons in India to acquire this new technology. The two surgeons, Kersi Dastur and PK Sen, pursued different strategies to acquire the ideas, equipment, and tacit knowledge needed to make open-heart surgery work. While Dastur tapped Parsi networks that linked him to local manufacturing expertise, Sen took advantage of opportunities offered by the Rockefeller Foundation to access international training and medical device companies. Each experienced steep learning curves as they pursued the know-how needed to use the machines successfully in dogs and then patients. The establishment of open-heart surgery in India required the investment of substantial labor and resources. Specific local, national, and transnational interests motivated the efforts. Heart-lung machines, for instance, took on new meanings amid the nationalist politics of independent India: Even as surgeons sought imported machines, they and their allies assigned considerable value to 'indigenous' innovation. The confluence of the many interests that made Sen and Dastur's work possible facilitated the uneasy co-existence of conflicting judgments about the success or failure of this medical innovation.
Assuntos
Comércio , Máquina Coração-Pulmão/história , Tecnologia/história , Cirurgia Torácica/história , Animais , Cães , Máquina Coração-Pulmão/economia , Máquina Coração-Pulmão/estatística & dados numéricos , História do Século XX , Humanos , Índia , Invenções/história , Cirurgia Torácica/métodos , Procedimentos Cirúrgicos Torácicos/história , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
Up until now time has rarely been considered in the historiography of surgery. However, the emergence of modern operating procedures is based significantly on establishing controlled relations of time by adjusting organic, technological and organizational processes. Early cardiac surgery in particular faced a crucial time problem: excluding the heart from the circulatory system long enough to operate inside its bloodless chambers. This problem can be traced back to the early 20th century, when surgeons such as Ludwig Rehn (1849-1930), Friedrich Trendelenburg (1844-1924), and Alexis Carrel (1873-1944) experimented with occlusions of the great vessels. Throughout the first half of the century, various attempts were made to prolong the possible time of circulatory arrest. In this regard, Arthur W. Meyer (1885-1934) in Berlin developed surgical craft procedures, John H. Gibbon Jr. (1903-1973) worked on constructing a heart-lung machine in Boston/Philadelphia, and Wilfred G. Bigelow in Toronto experimented with lowering the temperature of the body. Meticulous scrutiny of these developments illustrates how heterogeneous periods, rhythms, and paces had to be harmonized in order to gain decisive minutes or even seconds. Therefore, major developments on the way to open heart surgery can be described as a history of surgical time.
Assuntos
Procedimentos Cirúrgicos Cardíacos/história , Máquina Coração-Pulmão/história , Duração da Cirurgia , Parada Cardíaca Induzida/história , História do Século XX , HumanosRESUMO
Sixty years ago, at the Mayo Clinic in Rochester, Minnesota, an ambitious group of pioneers, led by Dr John W. Kirklin and supported by a multidisciplinary team of physicians and technicians embarked on a planned series of surgical cases using a heart-lung machine to allow direct visualization of the inside of the opened human heart to repair otherwise fatal congenital intracardiac defects. Their success sparked the beginning of a new era of open-heart surgery. In this historical article, we discuss the contributions of a few key figures of this revolution and also share the story of the first successful cardiac surgery operation using cardiopulmonary bypass performed at Mayo Clinic.
Assuntos
Procedimentos Cirúrgicos Cardíacos/história , Cardiologia/história , Cardiopatias/história , Hospitais/história , Cirurgia Torácica/história , Difusão de Inovações , Cardiopatias/cirurgia , Máquina Coração-Pulmão/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , MinnesotaRESUMO
OBJECTIVE: To provide a brief review of the development of cardiopulmonary bypass. METHODS: A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation. RESULTS: The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies. CONCLUSION: Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function.
Assuntos
Ponte Cardiopulmonar/instrumentação , Ponte Cardiopulmonar/tendências , Máquina Coração-Pulmão/tendências , Oxigenadores/tendências , Biomarcadores/análise , Ponte Cardiopulmonar/efeitos adversos , Citocinas/análise , Desenho de Equipamento , Máquina Coração-Pulmão/história , Hemólise , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Oxigenadores/históriaRESUMO
Abstract Objective: To provide a brief review of the development of cardiopulmonary bypass. Methods: A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation. Results: The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies. Conclusion: Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function. .
Resumo Objetivo: Relatar de forma simples e resumida o desenvolvimento da circulação extracorpórea. Métodos: Realizada revisão de literatura sobre a evolução da circulação extracorpórea, seu papel fundamental para cirurgia cardiovascular e as complicações que podem surgir após o seu uso, dentre elas, a hemólise e a inflamação. Resultados: O processo de desenvolvimento da circulação extracorpórea foi fundamental, diminuindo as complicações desencadeadas por ela, que acabam por repercutir no paciente, variando de lesões de graus variados até falência de múltiplos órgãos. Os pesquisadores estudaram quais as agressões que a circulação extracorpórea poderia suscitar no organismo humano. Possíveis soluções surgiram e, consequentemente, meios mais adequados para uma condução mais segura do pós-operatório foram propostas. Conclusão: A circulação extracorpórea progrediu a passos firmes e seguros ao longo destas últimas décadas desde a sua concepção por Gibbon. Apesar da sua evolução e das condutas realizadas na tentativa de amenizar as complicações, o respeito aos detalhes das funções fisiológicas do paciente é fundamental. .
Assuntos
História do Século XIX , História do Século XX , História do Século XXI , Humanos , Ponte Cardiopulmonar/instrumentação , Ponte Cardiopulmonar/tendências , Máquina Coração-Pulmão/tendências , Oxigenadores/tendências , Biomarcadores/análise , Ponte Cardiopulmonar/efeitos adversos , Citocinas/análise , Desenho de Equipamento , Hemólise , Máquina Coração-Pulmão/história , Oxigenadores/históriaAssuntos
Traumatismos Abdominais/história , Pesquisa Biomédica/história , Máquina Coração-Pulmão/história , Transplante de Órgãos/história , Procedimentos Cirúrgicos Vasculares/história , Lesões do Sistema Vascular/história , Traumatismos Abdominais/cirurgia , Desenho de Equipamento , França , História do Século XIX , História do Século XX , Humanos , Prêmio Nobel , Estados Unidos , Lesões do Sistema Vascular/cirurgiaRESUMO
Long periods of experimental research signify the struggle for the goal to substitute the functions of heart and lungs by a machine. In 1931, John Heysham Gibbon, a young surgeon in Boston began animal experiments concentrating on this task. After almost 20 years he succeeded, in May 1953, he performed the first successful open heart operation using a heart-lung machine in the world in Philadelphia. Almost simultaneously, a team of surgeons around Clarence Walton Lillehei in Minneapolis had the same intentions, yet using a different approach. They applied the method of cross-circulation where a parent of the sick child served as "temporary placenta" like a biological oxygenator. Their first successful operation occurred in March 1954. All over the world, many scientists worked intensely on that subject, but did not succeed. However, these two great personalities, persistent and ingenious, reached the same scientific target with very different methods. Thus, both created the foundation for modern cardiac surgery, which is now performed daily all over the world.
Assuntos
Pesquisa Biomédica/história , Procedimentos Cirúrgicos Cardíacos/história , Cirurgia Torácica/história , Animais , Máquina Coração-Pulmão/história , História do Século XX , HumanosRESUMO
Thomas Baffes developed one of the first operations for transposition of the great arteries directing inferior vena cava flow to the left atrium using an interposed homograft in the era before open heart surgery. He performed 117 Baffes operations from 1953 to 1960, with 30% overall mortality, and an additional 85 Baffes procedures before 1968, allowing many to survive until the atrial baffle operations. During the early days before hospitals had cardiopulmonary bypass machines, Tom Baffes and colleagues purchased a heart-lung machine and transported it to various Chicago hospitals to treat patients and stimulate interest in this emerging technology.
Assuntos
Ponte Cardiopulmonar/história , Papel do Médico , Transposição dos Grandes Vasos/cirurgia , Máquina Coração-Pulmão/história , História do Século XX , Estados UnidosAssuntos
Sociedades Médicas/história , Cirurgia Torácica/história , Procedimentos Cirúrgicos Torácicos/história , Ponte Cardiopulmonar/história , Educação Médica/história , Máquina Coração-Pulmão/história , História do Século XX , Humanos , Internato e Residência/história , Cirurgia Torácica/educação , Procedimentos Cirúrgicos Torácicos/educação , Estados UnidosRESUMO
Dr Willem J. Kolff was surely one of the greatest inventors/physicians/scientists/bioengineers of the last few hundred years. He was knighted (Commander of the Order of Oranje-Nassau) in 1970 by Queen Juliana of the Netherlands. In 1990, Life magazine published a list of its own 100 most important figures of the 20th century. Kolff stood in 99th place as the Father of Artificial Organs. Dr Kolff forged a path of innovative thinking and creativity that has had a huge impact on the quality of human life. His contributions to the development of the artificial kidney and dialysis, the heart-lung machine, the membrane oxygenator, potassium arrest of the heart, the AH, mechanical cardiac assistance, and other artificial organs, and his support and mentoring of hundreds to thousands of anesthesiologists, surgeons, and bioengineers throughout the world, have had a significant impact on anesthesiology and the medical community.
Assuntos
Anestesiologia/história , Cirurgia Torácica/história , Bioengenharia , Ponte Cardiopulmonar/história , Coração Artificial/história , Máquina Coração-Pulmão/história , História do Século XX , Humanos , Rins Artificiais/história , Mentores , Países Baixos , Médicos , Sociedades Médicas , Estados UnidosRESUMO
The development of the heart-lung machine and its first successful clinical application in 1953 was the culmination of Dr. Gibbon's lifetime research project. Despite many technical obstacles, financial problems, and discouragement from colleagues, his goal was achieved after twenty tedious years of tireless work. Posteriorly, his academic contribution established him as a leader and pioneer in the field of cardiac surgery. Parallel to his achievement and Dr. Kirklin's surgical experience, several authors around the world attempted open-heart surgery with the heart-lung machine, particularly in Europe. In Eastern Europe and particularly in the former Czechoslovakia, the lack of access to foreign medical literature forced a group of emerging young physicians from the Second Department of Surgery at Comenius University to furtively collect data on the topic. After building the Simkovic-Bolf heart-lung machine, the first successful open-heart surgery with the new device was performed only 5 years after Dr. Gibbons' experience (Tab. 1, Fig. 4, Ref. 22).
Assuntos
Máquina Coração-Pulmão/história , Cirurgia Torácica/história , Europa (Continente) , História do Século XX , EslováquiaRESUMO
Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.