[The Role of Extracorporeal Ventricular Assist Device is Changing in the Era of Implantable Ventricular Assist Device].

In the era of implantable ventricular assist device (VAD), the role of extracorporeal VAD is changing. The extracorporeal VAD was ever the mainstream of treatment for severe heart failure. Now, it is mainly applied to patients with severe cardiogenic shock. Recently the centrifugal pump available for cardiopulmonary bypass system has been often used as the extracorporeal VAD because of its simplicity of management. Although the implantable VAD plays the pivotal role for bridge to transplantation since its clinical introduction in 2011, the extracorporeal VAD still has the important role for end-stage heart failure and cardiogenic shock. We have experienced 47 cases of the extracorporeal VAD until now. Here, based on our experience, we describe the "past and present" role of the extracorporeal VAD and mention the future aspect of the extracorporeal VAD.

Cardiopulmonary bypass: development of John Gibbon's heart-lung machine.

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.

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. .

[Development of cardiovascular surgery]. / Zur Entwicklung der kardiovaskulären Chirurgie.

On the occasion of the 80th anniversary of the journal "Der Chirurg" (The Surgeon) this article summarizes the development of cardiac surgery. Beginning from the first cardiac suture in 1897 by Ludwig Wilhelm Carl Rehn, through the first catheter investigation of the heart by Werner Forssmann in 1923 to the year 2008 when nearly 100,000 cardiac interventions were carried out in Germany and of these some 90,000 using a heart-lung machine. The article describes the founding of the German Society for Thorax, Heart and Vascular Surgery in the year 1971 and the reintegration in the German Society for Surgery, stemming from efforts for the unification of the structure of further education (common trunk). The motto for this process, which was actively supported by both societies, was "Independence when necessary, cooperation when possible".

The place of research and the role of academic surgeons in cardiac surgery.

The development of the discipline of cardiac surgery was, to a large extent, guided by the vision and research of its pioneers. On the basis of their efforts, all the different areas of cardiac surgery were able to evolve including coronary artery bypass grafting, heart valve surgery, surgery of the aorta, congenital heart surgery, surgery for rhythm disorders including the implantation of pacemakers and defibrillators, and surgical treatment of advanced heart failure (for example, heart transplantations and mechanical circulatory support). The continued existence of cardiac surgery and its role in medicine in general will depend, to a significant extent, on the future research activities of its protagonists. Cardiac surgeon-scientists will play a pivotal role since they combine clinical experience with scientific knowledge and intuition which make them able to direct research to topics which will matter in the future. However, research costs money, and state or national funds will be not sufficient to support research as much as is necessary. Funding from third parties such as industry will increasingly be required. Due to this, however, the cardiac surgeon-scientist faces various challenges such as the evaluation of his skill in acquiring funds, conflicts with current ethical standards, conflicts of interest when receiving money from industry, and, as a result of the tough competition in this field, the temptation to commit fraud. The head of a department of cardiac surgery holds an important function as his initiative is decisive for the development of visions for the future and for the employment of surgeon-scientists who pursue visionary research. It will take the combined efforts of surgeon-scientists and departmental heads not only to maintain but to extend the position of cardiac surgery in medicine and society even further.

Controle automático de nível sangüíneo em osigenadores de circulação extracorpórea / Automatic blood level control for oxygenators used in extracorporeal circulation

Desde a primeira cirurgia cardíaca usando a técnica de circulação extracorpórea (CEG) em 1953, o avanço dos materiais e equipamentos e da própria técnica tem sido notável, reduzindo consideravelmente a ocorrência de acidentes relacionados à falhas mecânicas e/ou elétricas. Por outro lado, acidentes provocados por falha humana ainda ocorrem com certa freqüência, destacando-se a embolia aérea, na qual o reservatória de sangue do oxigenador esvazia-se em poucos segundos sem que o perfusionista perceba, resultando em uma injeção maciça de ar no paciente podendo deixá-lo com seqüelas graves ou levá-lo à morte. Visando aumentar a segurança da CEG e reduzir a possibilidade de ocorrência de embolia aérea provocada pelo esvaziamento acidental do oxigenador, foi desenvolvido um sistema de controle do nível de sangue no oxigenador que utiliza um sensor ultra-sônico e controla automaticamente a rotação da bomba sistêmica, além de acionar alarmes audiovisuais. Os resultados experimentais demonstraram a eficácia do equiapmento.

The total artificial heart.

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device.

Impact of the artificial lung on medical care.

Mechanical systems to oxygenate blood outside of the body were first employed in clinical medicine as a component of the "heart-lung machine". The artificial lung has been an essential component of the technology underlying the progress of cardiovascular surgery since 1950. Its impact on clinical medicine can be measured by the widespread acceptance of cardiac surgery for the treatment first of congenital malformations, then valvular lesions, and more recently, coronary artery disease. Whereas the use of the artificial lung during temporary exclusion of the pulmonary circulation for surgical purposes is now well established, the chronic application of extracorporeal membrane oxygenation and end-stage resporatory failure is still controversial. Internally implantable lung prostheses are still at the conceptual or developmental stage, and are unlikely to impact on clinical medicine for another decade.