Cardiopulmonary bypass: development of John Gibbon's heart-lung machine / Circulação extracorpórea: desenvolvimento da máquina de coração-pulmão de John Gibbon

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. .

Cincuenta años de circulación extracorpórea: la historia de la máquina corazón-pulmón / Fifty years of extracorporeal circulation: the history of the heart-lung machine

Si bien 1953 fue el año del descubrimiento del ADN y de la conquista del Monte Everest, también lo fue de un gran invento tecnológico: la máquina corazón-pulmón, la que ofreció un tratamiento, y en muchos casos cura, a la mayoría de las enfermedades cardiovasculares. En efecto, el 6 de mayo de 1953 John Gibbon logró coronar con el éxito el trabajo de toda su vida al cerrar por primera vez una comunicación interauricular en una joven mujer utilizando una máquina corazón-pulmón de su invención. Sin embargo, previamente la cirugía exploró otros caminos para operar el corazón, como la hipotermia, la que consistía en bajar la temperatura del paciente introduciéndolo en una tina de agua fría para luego efectuar la corrección quirúrgica de una malformación del corazón, en el menor tiempo posible. Por otra parte, luego de su primer éxito, los 4 pacientes siguientes de Gibbon fallecieron, por lo que este abandonó todo intento ulterior, lo que fue seguido por un pesimismo generalizado sobre la circulación extracorpórea. Este fue revertido un año más tarde por Walton Lillehei con la introducción de la "circulación cruzada controlada" en la que un paciente, habitualmente un niño, era conectado a un "donante", habitualmente el padre o la madre, cuyo corazón y pulmón servían como un oxigenador para así efectuar la cirugía a corazón abierto del paciente. Finalmente, es el mismo Lillehei, quien un año más tarde introduce el oxigenador de burbujas, simple y de bajo costo, que abrió las puertas de la cirugía a corazón abierto a todos los cirujanos del mundo. Por esto, para muchos, Walton Lillehei es considerado el "Padre de la Cirugía a Corazón Abierto". Lillehei visitó Chile en 1963 y luego de operar en los pabellones del Hospital Clínico de la Universidad Católica fue nombrado Miembro Honorario de la Facultad de Medicina de dicha Universidad. Previamente, en 1957, Helmuth Jaeger había efectuado el primer cierre quirúrgico exitoso de una comunicación interauricular con circul...

Cincuentenario de la máquina corazón-pulmón Un relato acerca de los pioneros y héroes y de las circunstancias que llevaron al gran invento que permitió el tratamiento y la cura de las enfermedades del corazón / Fifty years of the heart-lung machine. The report about the pioneers and heroes and about the circumstances that elevated the great invention, which allowed the treatment, and in many cases, the cure of heart illnesses

In 1953 DNA was discovered and the Everest was conquered but also a great invention was developed: the heart-lung machine, which allowed the treatment, and in many cases, the cure of most cardiovascular illnesses. In fact, on May 6, 1953 John Gibbon crowned with success the work of his entire life closing for the first time an atrial septal defect in a young woman using a heart-lung machine of his own invention. Before that, surgeons had explored other roads like hypothermia, cooling the patient in a cold water tub and then rapidly performing the surgical correction of a heart malformation. After his first success, the following 4 patients of Gibbon died, which led him to abandon heart surgery and produced a generalized pessimism about extracorporeal circulation. However, a year later Walton Lillehei reverted this situation with the introduction of controlled cross-circulation in which a patient, usually a child, was connected to a "donor", usually his father or mother, whose heart and lung served as a pump and oxigenator, allowing the performance of open heart surgery. Finally, it was Lillehei again who a year later introduced the bubble oxigenator, simple and inexpensive, opening the doors of open heart surgery to all surgeons around the world. For this, and many other reasons, Walton Lillehei is considered by most surgeons as the "Father of Open Heart Surgery". Lillehei visited Chile in 1963 and operated on a patient in the surgical theaters of the Hospital Clínico de la Universidad Católica and was named an Honorary Member of the School of Medicine of this University. Before that, in 1957 Helmut Jaeger at the Hospital Luis Calvo Mackenna performed the first successful surgical closure of an atrial septal defect with extracorporeal circulation in Chile using a De Wall-Lillehei bubble oxigenator (Rev Méd Chile 2003; 131: 1337-44).