The science and practice of cardiopulmonary bypass: From cross circulation to ECMO and SIRS

“Perfusion”: French verb ‘perfuse’ meaning to ‘pour over’. Heart disease is a major health problem in the World, and heart surgery is now common for revascularisation in coronary artery disease, heart valve repair and replacements, and heart and heartlung transplantation. This includes surgery for adults with acquired heart disease and corrective and palliative surgery for both children (including neonates and infants) and adults with congenital heart conditions. In England in the NHS, annually approximately 22–24,000 coronary artery bypass graft (CABG), operations and just over 11,000 valve procedures are performed. Whereas the number of CABGs performed has been approximately the same in recent years, valve surgery is increasing by about 5–10% every year. There is a general trend to more minimally invasive surgery and some surgeons are now using off pump surgery techniques. For congenital heart conditions, the number of procedures is increasing each year, especially for adults. Currently, it is estimated that more than one million cardiac operations are performed each year worldwide with use of the heart-lung machine. In most cases, the operative mortality is quite low, approaching 1% for some operations. Cardiopulmonary bypass (CPB) is a key component of these highly invasive surgical procedures, many of which are complex. CPB takes over the functions of the heart and lungs and maintains blood oxygenation and circulation to the body whilst the heart and lungs are stopped during surgery.