Cardiopulmonary

Cardiopulmonary Bypass
Bypass

Jiang Yingjiu
Associate Professor
Master Tutor

Cardiothoracic Department
The First Affiliated Hopital of Chongqing Medical University
Congenital heart disease,Tetralogy of Fallot
6 years old,15 kg weight.
cyanosis,clubbing fingers.

wouldn’t grown-up
unless recieved cardiac surgery
To repair the cardiac defects

Bloodless field
Motionless field

Stop the motion of the heart

and lungs
Bloodless?

Motionless?

Life maintenance?
Cardiopulmonary
Cardiopulmonary Bypass
Bypass
1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
 Cardiopulmonary
Cardiopulmonary Bypass
Bypass

Drains venous blood from the right atrium or vena cava by the
cannula inserted into the venous system.Finishs gas exchange
process including oxygen and carbon dioxide by the artifial
lung(oxygenator) to change the oxygen poor venous blood
into the oxygen rich arterial blood.Pumps oxygenated blood
back to the body by the artificial heart(pump) via arterial
cannula to remain the living of the all the other organs of the
body except the lung and the heart.
Provides a limited 2-3 hours time during which the lung and
the heart are not working for cardiac surgeon to open the heart
and finish a operation precisely with bloodless and motionless
field.
By this way,the function of the lung and heart had been
taken over by the extracorporeal circulation equipments.
Provide the desired bloodless, motionless operative field
and still supply all the other organs of the body with
oxygen and nutrient-rich blood.
Heat exchanger
Summary for CPB

1 Purpose:
1) To provide a bloodless, motionless field for heart surgery
2) Rest of body perfused while heart and lung stopped

2 Methods:
1) Drain out venous blood
2) Oxygenated by artificial lung
3) Oxygen-rich blood pumped back by artificial heart
History
Landmark in cardiac surgery!

Western countries in 1953

China in 1958

The hospital here

1963
1979
John H. Gibbon
吴英恺
1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
 Basic equipments
1 artificial heart (blood pump)
2 artificial lung (oxygenator)
3 temperature exchanger
4 filter
5 tubes or cannulas

Artificial
Artificial hypothemia
hypothemia

Using bionics principle of hibernation ， lowering the body

temperature can strengthen the tolerance ablility for hypoxia.
Decreasing 1 ℃ of the body temperature can reduce oxygen
consumption by 5%-6%. Decrease the body temperature to 28 ℃
-20 ℃, the metabolization will be reduced to 50%-80%. Therefore,
low temperature can enhance the body tolerance to hypoxia.
Combine the cardiopulmonary bypass and hypothermic anesthesia
together widely used in the treatment of heart disease for open
intracardio surgery.
 temperature exchanger

tubes
blood pump

oxygenator
1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
Typical process for open heart surgery

1 Anesthesia
2 Supine position
3 Median sternotomy
4 Incision of the skin and subcutaneous
5 Sternum divided by saw
5 Thymus isolated
6 Incision of pericardium
7 Heart and great vessels exposed

8 Heparinize

9 Exterior exploration

Chest opened by sternotomy

10 Cannulations for aorta,SVC,IVC
11 Connect cannulations to cardiopulmonary
bypass machine
the bypass system established
12 Start the bypass machine and
hypothermia
13 Aortic cross-clamp placed
cardioplegia injected
the heart arrested
14 Open the heart ………..

exploration and operation

Cardiopulmonary Bypass
Technique
Cardiopulmonary Bypass
Technique

Arterial & Venous Cannulation

 Myocardial Protection
Strategies:
1 Hypothermia
cold perfusate
surface cooling

2 Cardioplegia
 K+
diastolic arrest Intermittent perfusion
 Myocardial Protection
Cardioplegia:

 Route of administration

Antegrade Retrograde
Nonpulsatile / pulsatile flow
C.O. - 2-2.5 L/min/m2

CPB under going

15 Re-warming
de-air
release aortic clamp
heart resuscitation
heart beating again
16 Heart incision suture
17 Off pump gradually
remove the pipelines
18 Administration of protamine
neutralize against heparin
restore clotting function
19 Sternal fixation with wire
20 Close the skin incision
Anesthesia
Median sternotomy
Incision of pericardium
Exterior exploration
Heparinize
Cannulations for aorta,SVC,IVC
Start the bypass machine and
hypothermia
Aortic cross-clamp placed
Cardioplegia injected
Intracardiac exploration and
open-heart operation
Re-warming,de-air,release aortic
clamp,heart resuscitation
Off pump gradually
Neutralize against heparin
restore clotting function
Sternal fixation with wire
Close the skin incision
1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
Clinical application:

All the operations need open the heart

Congenital heart disease

Cardiac valve disease

Coronary artery disease

Great vessel disease

Extended radical operation for various chest tumor

Congenital heart disease
Cardiac valve disease
Coronary artery disease
Great vessel disease
1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
Pathophysiology after bypass

1 Metabolic changes: acidosis and alkalosis

2 Electrolytes turbulence: hypokalemia

3 Blood damage: blood cell damage,coagulation disorder

4 Renal or lung function decrease or damage

1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
1 Haemodynamic stability

2 Correcting acid-base imbalance

and electrolyte disturbance

3 Protection of renal function

4 Assisted mechanical ventilation

1 Definition
2 Basical equipments
3 Essential steps
4 Clinical application
5 Pathophysiology
6 Postoperative treatment
Thanks