Skip to main content
SpringerLink
Log in

Cardiopulmonary Bypass and Cardioplegia

  • Chapter
Handbook of Cardiac Anatomy, Physiology, and Devices

  • 130k Accesses

Abstract

This chapter describes the history and techniques of cardiopulmonary bypass, a process that effectually excludes the heart from the general circulation and leaves it empty so that it can accommodate open cardiac surgical intervention. Since its first implementation, cardiopulmonary bypass has improved significantly to become a very highly sophisticated, but reliably performed procedure. The near future promises even more improvements because research and innovations continue to make cardiac operations safer and more efficient.

With the advent of coronary bypass in the late 1960s and early 1970s, surgeons became increasingly interested in finding ways to protect the heart during the period of global ischemia via infusion of cold perfusates into the coronary circulation (i.e., cardioplegia). Therefore, this chapter further details the advantages and disadvantages of various cardioplegia solutions which have been developed at several separate institutions, including extracellular- and intracellular-type solutions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lillehei CW, Cohen M, Warden HE, Varco RL (1955) The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation. Surgery 38:11–29

    CAS  PubMed  Google Scholar 

  2. Gibbon JH (1954) Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 37:171–180

    PubMed  Google Scholar 

  3. Sabik JF, Nemeh H, Lytle BW et al (2004) Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg 77:1315–1320

    Article  PubMed  Google Scholar 

  4. Svensson LG, Kim KH, Blackstone EH et al (2004) Elephant trunk procedure: newer indications and uses. Ann Thorac Surg 78:109–116, discussion 109–116

    Article  PubMed  Google Scholar 

  5. Bjork VO, Hultquist G (1962) Contraindications to profound hypothermia in open-heart surgery. J Thorac Cardiovasc Surg 44:1–13

    CAS  PubMed  Google Scholar 

  6. Brunberg JA, Reilly EL, Doty DB (1974) Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest. Circulation 60:49–50

    Google Scholar 

  7. Bell WR, Royall RM (1980) Heparin-associated thrombocytopenia: a comparison of three heparin preparations. N Engl J Med 303:902–907

    Article  CAS  PubMed  Google Scholar 

  8. Fadali MA, Papacostas CA, Duke JJ et al (1976) Cardiovascular depressant effect of protamine sulfate: experimental study and clinical implications. Thorax 31:320–323

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Goldman BS, Joison J, Austen WG (1969) Cardiovascular effects or protamine sulfate. Ann Thorac Surg 7:459–471

    Article  CAS  PubMed  Google Scholar 

  10. Greinacher A, Volpel H, Janssens U et al (1999) Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia: a prospective study. Circulation 99:73–80

    Article  CAS  PubMed  Google Scholar 

  11. Rowlings PA, Evans S, Mansberg R, Rozenberg MC, Evans S, Murray B (1991) The use of a low molecular weight heparinoid (Org 10172) for extracorporeal procedures in patients with heparin dependent thrombocytopenia and thrombosis. Aust N Z J Med 21:52–54

    Article  CAS  PubMed  Google Scholar 

  12. Warkentin TE, Greinacher A (2003) Heparin-induced thrombocytopenia and cardiac surgery. Ann Thorac Surg 76:2121–2131

    Article  PubMed  Google Scholar 

  13. Molina JE, Irmiter RJ, Vogelpohl DC, Nielsen KL, Callander D, Mueller R (1995) Normothermic cardiopulmonary bypass for all cardiac operations. Cor Europ 4:76–79

    Google Scholar 

  14. Sing AK, Bert AA, Feng WC, Rotenberg FA (1995) Stroke during coronary artery bypass grafting using hypothermic versus normothermic perfusion. Ann Thorac Surg 59:84–89

    Article  Google Scholar 

  15. Lazenby WD, Ko W, Zelano JA et al (1992) Effects of temperature and flow rate in regional blood flow and metabolism during cardiopulmonary bypass. Ann Thorac Surg 53:957–964

    Article  CAS  PubMed  Google Scholar 

  16. Nomoto S, Shimahara Y, Kumada K, Ogino H, Okamoto Y, Band T (1992) Arterial ketone body ratio during and after cardiopulmonary bypass. J Thorac Cardiovasc Surg 103:1164–1167

    CAS  PubMed  Google Scholar 

  17. Croughwell ND, Frasco P, Blumenthal JA, Leone BJ, White WD, Reves JG (1992) Warming during cardiopulmonary bypass is associated with jugular bulb desaturation. Ann Thorac Surg 53:827–832

    Article  CAS  PubMed  Google Scholar 

  18. Durandy Y, Hulin S, LeCompte Y (2002) Normothermic cardiopulmonary bypass in pediatric surgery. J Thorac Cardiovasc Surg 123:194

    Article  PubMed  Google Scholar 

  19. Swaminathan M, East C, Phillips-Bute B et al (2001) Report of a sub-study on warm versus cold cardiopulmonary bypass: changes in creatinine clearance. Ann Thorac Surg 72:1603–1609

    Article  CAS  PubMed  Google Scholar 

  20. Mora CT, Henson WB, Weintraub WS et al (1996) The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization. J Thorac Cardiovasc Surg 112:514–522

    Article  CAS  PubMed  Google Scholar 

  21. Craver JM, Bufkin BL, Weintraub WS, Guyton RA (1995) Neurologic events after coronary bypass grafting: further observations with warm cardioplegia. Ann Thorac Surg 59:1429–1433

    Article  CAS  PubMed  Google Scholar 

  22. Naik SK, Knight A, Elliot M (1991) A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 84:422–431

    Google Scholar 

  23. Davies MJ, Nguyen K, Gaynor JW, Elliot MJ (1998) Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:361–370

    Article  CAS  PubMed  Google Scholar 

  24. Loor G, Li L, Sabik JF 3rd, Rajeswaran J, Blackstone EH, Koch CG (2012) Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac Cardiovasc Surg 144:654–662

    Article  PubMed  Google Scholar 

  25. Loor G, Rajeswaran J, Li L et al (2013) The least of three evils: exposure to red blood cell transfusion, anemia or both? J Thorac Cardiovasc Surg 146:1480–1487

    Article  PubMed  Google Scholar 

  26. Loor G, Koch CG, Sabik JF 3rd, Li L, Blackstone (2012) Implications and management of anemia in cardiac surgery: current state of knowledge. J Thorac Cardiovasc Surg 144:538–546

    Google Scholar 

  27. Mahoney CB, Donnelly JE (2000) Impact of closed versus open venous reservoirs on patient outcomes in isolated coronary artery bypass surgery. Perfusion 15:467–472

    Article  Google Scholar 

  28. McCusker K, Vijay V, DeBois W et al (2001) MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery. Perfusion 16:447–452

    Article  CAS  PubMed  Google Scholar 

  29. Aldea GS, Doursovnian M, O’Gara P et al (1996) Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective randomized study. Ann Thorac Surg 62:410–417

    Article  CAS  PubMed  Google Scholar 

  30. Svenmarker S, Haggmark S, Jansson E et al (2002) Use of heparin-bonded circuits in cardiopulmonary bypass improves clinical outcome. Scand Cardiovasc J 35:241–246

    Article  Google Scholar 

  31. Molina JE (1989) Temporary dual-chamber pacing after open cardiac procedures. Medtronic News 19:24–28

    Google Scholar 

  32. Svensson LG, Crawford ES (eds) (1997) Cardiovascular and vascular disease of the aorta. WB Saunders Co., Philadelphia

    Google Scholar 

  33. Melrose DG, Dreyer B, Bentall HH, Baker JB (1955) Elective cardiac arrest. Preliminary communication. Lancet 2:21–22

    Article  Google Scholar 

  34. Helmsworth JA, Kaplan S, Clark LC Jr, McAdams AJ, Matthews EC, Edwards FK (1959) Myocardial injury associated with asytole induced with potassium citrate. Ann Surg 149:200–203

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Brewer DL, Bilbro RH, Bartel AG (1973) Myocardial infarction as a complication of coronary bypass surgery. Circulation 47:58–64

    Article  CAS  PubMed  Google Scholar 

  36. Assad-Morell JL, Wallace RB, Elveback LR et al (1975) Serum enzyme data in diagnosis of myocardial infarction during or early after aorto-coronary saphenous vein bypass graft operations. J Thorac Cardiovasc Surg 69:851–857

    CAS  PubMed  Google Scholar 

  37. Hearse DJ, Stewart DA, Braimbridge MV (1975) Hypothermic arrest and potassium arrest: metabolic and myocardial protection during elective cardiac arrest. Circ Res 36:481–489

    Article  CAS  PubMed  Google Scholar 

  38. Nelson RL, Goldstein SM, McConnell DH, Maloney JV, Buckberg GD (1976) Improved myocardial performance after aortic cross-clamping by combining pharmacologic arrest with topical hypothermia. Circulation 54:11–16

    Google Scholar 

  39. Buckberg GD, Olinger GN, Mulder DG, Maloney JV (1975) Depressed postoperative cardiac performance: prevention by adequate myocardial protection during cardiopulmonary bypass. J Thorac Cardiovasc Surg 70:974–994

    CAS  PubMed  Google Scholar 

  40. Molina JE, Feiber W, Sisk A, Polen T, Collins B (1977) Cardioplegia without fibrillation or defibrillation in cardiac surgery. Surgery 81:619–626

    CAS  PubMed  Google Scholar 

  41. Roe BB, Hutchinson JC, Fishman NH, Ullyot DJ, Smith DL (1977) Myocardial protection with cold ischemic potassium induced cardioplegia. J Thorac Cardiovasc Surg 73:366–374

    CAS  PubMed  Google Scholar 

  42. Chocron S, Kaili D, Yan Y et al (2000) Intermediate lukewarm (20°C) antegrade intermittent blood cardioplegia compared with cold and warm blood cardioplegia. J Thorac Cardiovasc Surg 119:610–616

    Article  CAS  PubMed  Google Scholar 

  43. Rosenkranz ER, Vinten-Johansen J, Buckberg GD, Okamoto F, Edwards H, Bugyi H (1982) Benefits of normothermic induction of blood cardioplegia in energy-depleted hearts, with maintenance of arrest by multidose cold blood cardioplegic infusions. J Thorac Cardiovasc Surg 84:667–677

    CAS  PubMed  Google Scholar 

  44. Hayashida N, Ikonomidis JS, Weisel RD et al (1994) The optimal cardioplegic temperature. Ann Thorac Surg 58:961–971

    Article  CAS  PubMed  Google Scholar 

  45. Follete DM, Fey K, Becker H et al (1979) Superiority of blood cardioplegia over asanguineous cardioplegia: an experimental and clinical study. Chir Forum Exp Klin Forsch 279–283

    Google Scholar 

  46. Hearse DJ, Stewart DA, Braimbridge MV (1976) Cellular protection during myocardial ischemia: the development and characterization of a procedure for the induction of reversible ischemic arrest. Circulation 54:193–202

    Article  CAS  PubMed  Google Scholar 

  47. Ebert PA, Greenfield LJ, Austen WG, Morrow AG (1962) Experimental comparison of methods for protecting the heart during aortic occlusion. Ann Surg 155:25–32

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Rosenkranz ER, Buckberg GD, Laks H, Mulder DG (1983) Warm induction of cardioplegia with glutamate-enriched blood in coronary patients with cardiogenic shock who are dependent on inotropic drugs and intra-aortic balloon support. J Thorac Cardiovasc Surg 86:507–518

    CAS  PubMed  Google Scholar 

  49. Beyersdorf F, Kirsh M, Buckberg GD, Allen BS (1992) Warm glutamate/aspartate-enriched blood cardioplegic solution for perioperative sudden death. J Thorac Cardiovasc Surg 104:1141–1147

    CAS  PubMed  Google Scholar 

  50. Jynge P, Hearse DJ, Braimbridge MV (1977) Myocardial protection during ischemic cardiac arrest. A possible hazard with calcium-free cardioplegic infusates. J Thorac Cardiovasc Surg 73:848–855

    CAS  PubMed  Google Scholar 

  51. Harlan BJ, Ross D, Macmanus Q, Knight R, Luber J, Starr A (1978) Cardioplegic solutions for myocardial preservation: analysis of hypothermic arrest, potassium arrest, and procaine arrest. Circulation 58:114–118

    CAS  Google Scholar 

  52. Conti VR, Bertranov EG, Blackstone EH, Kirklin JW, Digerness SB (1978) Cold cardioplegia versus hypothermia for myocardial protection: randomized clinical study. J Thorac Cardiovasc Surg 76:577–589

    CAS  PubMed  Google Scholar 

  53. Kirklin JW, Conti VR, Blackstone EH (1979) Prevention of myocardial damage during cardiac operations. N Engl J Med 301:135–141

    Article  CAS  PubMed  Google Scholar 

  54. Bretschneider J, Hubner G, Knoll D, Lohr B, Nordbeck H, Spieckermann PG (1975) Myocardial resistance and tolerance to ischemia: physiological and biochemical basis. J Cardiovasc Surg (Torino) 16:241–260

    CAS  Google Scholar 

  55. Preusse CJ, Gebhard MM, Bretschneider HJ (1981) Myocardial “equilibration processes” and myocardial energy turnover during initiation of artificial cardiac arrest with cardioplegic solution-reasons for a sufficiently long cardioplegic perfusion. Thorac Cardiovasc Surg 29:71–76

    Article  CAS  PubMed  Google Scholar 

  56. Preusse CJ, Schulte HD, Birks W (1987) High volume cardioplegia. Ann Chirurg Gynaecol 76:39–45

    CAS  Google Scholar 

  57. Human PA, Holl J, Vosloo S et al (1993) Extended cardiopulmonary preservation: University of Wisconsin solution versus Bretschneider’s cardioplegic solution. Ann Thorac Surg 55:1123–1130

    Article  CAS  PubMed  Google Scholar 

  58. Reichenspurner H, Russ C, Uberfuhr P et al (1992) Myocardial preservation using HTK-solution for heart transplantation. A multicenter study. Eur J Cardiothorac Surg 7:414–419

    Article  Google Scholar 

  59. Groenewoud AF, Thorogood J (1992) A preliminary report of the HTK randomized multicenter study comparing kidney graft preservation with HTK and Eurocollins solutions. Transpl Int 5:429–432

    Google Scholar 

  60. Hewitt RL, Lolley DM, Adrouny GA, Drapanas T (1974) Protective effect of glycogen and glucose on the anoxic arrested heart. Surgery 75:1–10

    CAS  PubMed  Google Scholar 

  61. Lolley DM, Ray JF III, Myers WO, Sheldon G, Sautter RD (1978) Reduction of intraoperative myocardial infarction by means of exogenous anaerobic substrate enhancement: prospective randomized study. Ann Thorac Surg 26:515–524

    Article  CAS  PubMed  Google Scholar 

  62. Molina JE, Gani KS, Voss DM (1982) How should clear cardioplegia be administered? A method of rapid arrest with high flow and pressure. J Thorac Cardiovasc Surg 84:762–772

    CAS  PubMed  Google Scholar 

  63. Molina JE, Gani KS, Voss DM (1982) Pressurized rapid cardioplegia versus administration of exogenous substrate and topical hypothermia. Ann Thorac Surg 33:434–444

    Article  CAS  PubMed  Google Scholar 

  64. Molina JE, Galliani CA, Einzig S, Bianco R, Rasmussen T, Clack R (1989) Physical and mechanical effects of cardioplegic injection on flow distribution and myocardial damage in hearts with normal coronary arteries. J Thorac Cardiovasc Surg 97:870–877

    CAS  PubMed  Google Scholar 

  65. Todd GJ, Tyers GF (1975) Amelioration of the effects of ischemic cardiac arrest by the intracoronary administration of cardioplegic solutions. Circulation 52:1111–1116

    Article  CAS  PubMed  Google Scholar 

  66. Fremes SE, Zhang J, Furukawa RD, Mickle DA, Weisel RD (1995) Cardiac storage with University of Wisconsin solution, calcium, and magnesium. J Heart Lung Transplant 14:916–925

    CAS  PubMed  Google Scholar 

  67. Ackemann J, Gross W, Mory M, Schaefer M, Gebhard MD (2002) Celsior versus Custodiol: early postischemic recovery after cardioplegia and ischemia at 5°C. Ann Thorac Surg 74:522–529

    Article  PubMed  Google Scholar 

  68. Coles JA Jr, Sigg DC, Iaizzo PA (2005) The potential benefits of 1.5% hetastarch as a cardioplegia additive. Biochem Pharmacol 69:1553–1558

    Article  CAS  PubMed  Google Scholar 

  69. Nayler WG (1982) Protection of the myocardium against postischemic reperfusion damage. The combined effect of hypothermia and nifedipine. J Thorac Cardiovasc Surg 84:897–905

    CAS  PubMed  Google Scholar 

  70. Bolling SF, Bies LE, Gallagher KP, Bove EL (1989) Enhanced myocardial protection with adenosine. Ann Thorac Surg 47:809–815

    Article  CAS  PubMed  Google Scholar 

  71. Sharov VG, Saks VA, Kupriyanov VV et al (1987) Protection of ischemic myocardium by exogenous phosphocreatine. J Thorac Cardiovasc Surg 94:749–761

    CAS  PubMed  Google Scholar 

  72. Foker JE, Einzig S, Wang T (1980) Adenosine metabolism and myocardial preservation. J Thorac Cardiovasc Surg 80:506–516

    CAS  PubMed  Google Scholar 

  73. Vejlsted H, Andersen K, Hansen BF et al (1983) Myocardial preservation during anoxic arrest. Scand J Thorac Cardiovasc Surg 17:269–276

    Article  CAS  PubMed  Google Scholar 

  74. Rao G, King J, Ford W, King G (1977) The effects of methylprednisolone on the complications of coronary artery surgery. Vasc Surg 11:1–7

    Article  CAS  PubMed  Google Scholar 

  75. Kirsh MM, Behrendt DM, Jochim KE (1979) Effects of methylprednisolone in cardioplegic solution during coronary bypass grafting. J Thorac Cardiovasc Surg 77:896–899

    CAS  PubMed  Google Scholar 

  76. The Warm Heart Investigators (1994) Randomized trial of normothermic versus hypothermic coronary bypass surgery. Lancet 343:559–563

    Article  Google Scholar 

  77. Menasche P, Kural S, Fauchet M et al (1982) Retrograde coronary sinus perfusion. A safe alternative for ensuring cardioplegic delivery in aortic valve surgery. Ann Thorac Surg 34:647–658

    Article  CAS  PubMed  Google Scholar 

  78. Lichtenstein SV, Ashe KA, El Dalati H, Cusimano RJ, Panos A, Slutsky AS (1991) Warm heart surgery. J Thorac Cardiovasc Surg 101:269–274

    CAS  PubMed  Google Scholar 

  79. Wechsler AS (1982) Deficiencies of cardioplegia—the hypertrophied ventricle. In: Engelman RM, Levisky S (eds) A textbook of clinical cardioplegia. Futura, Mount Kisco, pp 381–439

    Google Scholar 

  80. Shumway NE, Lower RR, Stofer RC (1959) Selective hypothermia of the heart in anoxic cardiac arrest. Surg Gynecol Obstet 109:750–754

    CAS  PubMed  Google Scholar 

  81. Shumway NE, Lower RR (1959) Topical cardiac hypothermia for extended periods of anoxic arrest. Surg Forum 10:563–566

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware St. SE, MMC 207, Minneapolis, MN, 55455, USA

    Gabriel Loor MD & J. Ernesto Molina MD, PhD

Authors
  1. Gabriel Loor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Ernesto Molina MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriel Loor MD .

Editor information

Editors and Affiliations

  1. B172 Mayo, MMC 195, University of Minnesota Department of Surgery, Minneapolis, Minnesota, USA

    Paul A. Iaizzo

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Loor, G., Molina, J.E. (2015). Cardiopulmonary Bypass and Cardioplegia. In: Iaizzo, P. (eds) Handbook of Cardiac Anatomy, Physiology, and Devices. Springer, Cham. https://doi.org/10.1007/978-3-319-19464-6_33

Download citation

Publish with us

Policies and ethics

Search

Navigation