Cardiopulmonary bypass technologies - Biomaterials and Devices for the Circulatory System - page 139

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Cardiopulmonary bypass technologies

S. GUNAYDIN, University of Kirikkale, Turkey

Abstract : Cardiopulmonary bypass (CPB) has revolutionized our
ability to operate on the heart, great vessels, and aorta in addition to
providing means of short-term support for reversible causes of
cardiac and/or respiratory failure. This chapter summarizes current
concepts of CPB with particular emphasis on the biomaterial
developments currently taking place. Although routine application of
CPB is shrinking under pressure from less invasive techniques, this may
represent an opportunity to deliver a more highly evolved perfusion to
the core of very sick and complex patients who may not be suitable
candidates for alternative therapy. These patients will benefi t from the
application of new technologies currently under development, such as
smaller perfusion circuits, fi ltration techniques, improved biomaterial
surfaces, smart membranes, and biosensor technology, all aimed at
making clinical perfusion a safer and more predictable procedure for
the patient.

Key words : cardiopulmonary bypass, extracorporeal circulation.

6.1 Introduction

Approximately 800 000 operations worldwide are performed annually with
the assistance of cardiopulmonary bypass (CPB). With respect to the age
and physical condition of patients, all surgeons have found a shift toward
older, frailer adults on one hand and younger children on the other. The
results of this displacement could be altered to the benefi t of the patients
undergoing open heart surgery by continual improvement of the operative
techniques as well as the technology of CPB systems.
A number of different strategies, including new pharmacologic agents,
CPB circuits and components, and surgical techniques have been employed
during the last few years in attempts to minimize the impact of systemic
infl ammatory response on the outcome and targeting blood conservation
for cardiac surgical patients.
The improved utilization of biomaterials in CPB is dependent on polymer
science and technology, procedures for blood compatibility assessment,
optimization of biomaterial/antithrombotic agent combinations, and the
interpretation of clinical data. 1 Cardiovascular industry has made excellent
strides over the past few decades in optimizing every component of the
CPB circuit but despite many theoretical opportunities and possibilities, the

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