40:
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1131:. The pursestrings sutures are cinched around the cannula using a tourniquet and secured to the cannula. At this point, the perfusionist advances the arterial line of the CPB circuit and the surgeon connects the arterial line coming from the patient to the arterial line coming from the CPB machine. Care must be taken to ensure no air is in the circuit when the two are connected, or else the patient could develop an
271:, requires the use of CPB. This is to avoid engulfing air systemically, and to provide a bloodless field to increase visibility for the surgeon. The machine pumps the blood and, using an oxygenator, allows red blood cells to pick up oxygen, as well as allowing carbon dioxide levels to decrease. This mimics the function of the heart and the lungs, respectively.
682:
worsens as complement proteins build on the membrane oxygenators. For this reason, most oxygenators come with a manufacturer's recommendation that they are only used for a maximum of six hours, although they are sometimes used for up to ten hours, with care being taken to ensure they do not clot off and stop working. For longer periods than this, a
717:(NPH) insulin formulations), are at an increased risk of type II protamine reactions due to cross-sensitivity. Because protamine is a fast-acting drug, it is typically given slowly to allow for monitoring of possible reactions. The first step in management of a protamine reaction is to immediately stop the protamine infusion.
1191:
is placed across the aorta between the arterial cannula and cardioplegia cannula to prevent the arterial blood from flowing backwards into the heart. Setting appropriate blood pressure targets to maintain the health and function of the organs including the brain and kidney are important considerations.
1190:
At this point, the patient is ready to go on bypass. Blood from the venous cannula(s) enters the CPB machine by gravity where it is oxygenated and cooled (if necessary) before returning to the body through the arterial cannula. Cardioplegia can now be administered to stop the heart, and a cross-clamp
1174:
cannulas are also required. Antegrade cardioplegia (forward flowing, through the heart's arteries), retrograde cardioplegia (backwards flowing, through the heart's veins), or both types may be used depending on the operation and surgeon preference. For antegrade cardioplegia, a small incision is made
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is less common, the inspection or use of an ultrasound for calcification at the cannulation sites is unnecessary. Also, because the venous system is under much less pressure than the arterial system, only a single suture is required to hold the cannula in place. If only a single cannula is to be used
728:
CPB may contribute to immediate cognitive decline. The heart-lung blood circulation system and the connection surgery itself release a variety of debris into the bloodstream, including bits of blood cells, tubing, and plaque. For example, when surgeons clamp and connect the aorta to tubing, resulting
681:
CPB is not without risk, and there are a number of associated problems. As a consequence, CPB is only used during the several hours a cardiac surgery may take. CPB is known to activate the coagulation cascade and stimulate inflammatory mediators, leading to hemolysis and coagulopathies. This problem
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in the right atrium, vena cava, or femoral vein to withdraw blood from the body. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but there is a possibility that it is inserted in the femoral artery, axillary artery, or brachiocephalic artery according to the
875:
are sewn into the patient's body in a variety of locations, depending on the type of surgery. A venous cannula removes oxygen depleted venous blood from a patient's body, and an arterial cannula infuses oxygen-rich blood into the arterial system. The main determinants of cannula size selection is
499:
is thoracic system variation in which the left-sided vena cava fails to involute during normal development. It is the most common variation of the thoracic venous system, occurring in approximately 0.3% of the population. The abnormality is often detected on pre-operative imaging studies, but may
307:
The blood is cooled during CPB and is returned to the body. The cooled blood slows the body's basal metabolic rate, decreasing its demand for oxygen. Cooled blood usually has a higher viscosity, but the various crystalloid or colloidal solutions that are used to prime the bypass tubing serve to
862:
Because hypothermia is frequently used in CPB (to reduce metabolic demands), heat exchangers are implemented to warm and cool blood within the circuit. Heating and cooling is accomplished by passing the line through a warm or ice water bath, and a separate heat exchanger is required for the
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that conducted the first human operation involving open cardiotomy with temporary mechanical takeover of both heart and lung functions. The patient did not survive due to an unexpected complex congenital heart defect, but the machine had proved to be workable. One member of the team was Dr
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of direct-contact oxygenators. Much work since the 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high-performance microporous hollow-fibre oxygenators that eventually replaced direct-contact oxygenators in cardiac theatres.
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Cardioplegia is a fluid solution used to protect the heart during CPB. It is delivered via a cannula to the opening of the coronary arteries (usually by way of the aortic root) and/or to the cardiac veins (by way of the coronary sinus). These delivery methods are referred to
826:. The pumps are more affordable than their centrifugal counterparts but are susceptible to over-pressurization if the lines become clamped or kinked. They are also more likely to cause a massive air embolism and require constant, close supervision by the perfusionist.
308:
dilute the blood. Maintaining appropriate blood pressure for organs is a challenge, but it is monitored carefully during the procedure. Hypothermia is also maintained (if necessary), and the body temperature is usually kept at 28 to 32 °C (82 to 90 °F).
251:
CPB is commonly used in operations or surgical procedures involving the heart. The technique allows the surgical team to oxygenate and circulate the patient's blood, thus allowing the surgeon to operate safely on the heart. In many operations, such as
1344:
and developed into practical extracorporeal oxygenators by French and German experimental physiologists in the 19th century. Bubble oxygenators have no intervening barrier between blood and oxygen, these are called 'direct contact' oxygenators.
1080:
demand of the surgery. After the cannula is inserted, venous blood is drained from the body by the cannula into a reservoir. This blood is then filtered, cooled, or warmed, and oxygenated before it returns to the body through a mechanical pump.
1757:
Arthursson H, Kjellberg G, Tovedal T, Lennmyr F. Cerebral oxygenation and autoregulation during rewarming on cardiopulmonary bypass. Perfusion. 2023 Apr;38(3):523-529. doi: 10.1177/02676591211064961. Epub 2022 Jan 17. PMID: 35038948; PMCID:
1357:
In 1983, Ken Litzie patented a closed emergency heart bypass system which reduced circuit and component complexity. This device improved patient survival after cardiac arrest because it could be rapidly deployed in non-surgical settings.
481:. Because heparin is typically used in CPB, patients who are known to have the antibodies responsible for heparin-induced thrombocytopenia and heparin-induced thrombocytopenia and thrombosis require alternative forms of anticoagulation.
1163:, through the tricuspid valve, and into the inferior vena cava. If two cannula are required (single-stage cannulation), the first one is typically passed through the superior vena cava and the second through the inferior vena cava. The
729:
emboli may block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery.
1026:, respectively. Cardioplegia solution protects the heart by arresting, or stopping the heart. This then decreases the heart's metabolic demand. There are multiple types of cardioplegia solutions, but most work by inhibiting
327:
and an oxygenator to temporarily take over the function of heart and/or the lungs. ECMO is useful for post-cardiac surgery patients with cardiac or pulmonary dysfunction, patients with acute pulmonary failure, massive
1547:"The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass"
492:, may exhibit resistance to heparin. In these patients, patients may need additional heparin, fresh frozen plasma, or other blood products such as recombinant anti-thrombin III to achieve adequate anticoagulation.
802:. This type of pumping action is considered to be superior to the roller pump because it is thought to prevent over-pressurization, clamping, or kinking of lines, and makes less damage to blood products (
165:. The machine mechanically circulates and oxygenates blood throughout the patient's body while bypassing the heart and lungs allowing the surgeon to work in a bloodless surgical field.
335:
ECMO gives the heart and/or lungs time to repair and recover, but is only a temporary solution. Patients with terminal conditions, cancer, severe nervous system damage, uncontrolled
1175:
in the aorta proximal to the arterial cannulation site (between the heart and arterial cannulation site) and the cannula is placed through this to deliver cardioplegia to the
1127:
is made within the pursestrings and the arterial cannula is passed through the incision. It is important the cannula is passed perpendicular to the aorta to avoid creating an
459:
There are no absolute contraindications to cardiopulmonary bypass. However, there are several factors that need to be considered by the care team when planning an operation.
2394:, Litzie K, Roberts CP, "US Patent for Emergency bypass system", issued 10 September 1985, assigned to C.R. Bard, Inc and Lifestream International, LLC.
507:
Cerebral perfusion, brain blood circulation, always has to be under consideration when using CPB. Due to the nature of CPB and it´s impact on circulation, the body´s own
2232:
243:
Illustration of one typical way that a heart-lung machine may be connected to the veins and arteries near the heart. The three implements on the left represent (
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CPB requires significant forethought before surgery. In particular, the cannulation, cooling, and cardio-protective strategies must be coordinated between the
745:. These units remove oxygen-depleted blood from a patient's body and replace it with oxygen-rich blood through a series of tubes, or hoses. Additionally, a
500:
also be discovered intra-operatively. A persistent left superior vena cava may make it difficult to achieve proper venous drainage or deliver of retrograde
1088:
A CPB circuit must be primed with fluid and all air expunged from the arterial line/cannula before connection to the patient. The circuit is primed with a
485:
is the most studied heparin-alternative in people with heparin-induced thrombocytopenia and heparin-induced thrombocytopenia and thrombosis requiring CPB.
2296:"A Tribute to Frank F Alibritten, Jr. Origin of the left ventricular vent during the early years of open-heart surgery with the Gibbon heart-lung machine"
2058:
Kotani, Yuki; Kataoka, Yuki; Izawa, Junichi; Fujioka, Shoko; Yoshida, Takuo; Kumasawa, Junji; Kwong, Joey SW (2022-11-30). Cochrane Heart Group (ed.).
686:
is used, which can be in operation for up to 31 days – such as in a
Taiwanese case, for 16 days, after which the patient received a heart transplant.
1092:
solution and sometimes blood products are also added. Prior to cannulation (typically after opening the pericardium when using central cannulation),
2496:
504:. Management of a persistent left superior vena cava during CPB depends on factors such as the size and drainage site of the vena cava variation.
1288:
466:
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for the maintenance and control of blood flow during CPB. By altering the speed of revolution (RPM) of the pump head, blood flow is produced by
69:
1744:
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1433:
2536:
2158:"Development of a pump-oxygenator to replace the heart and lungs; an apparatus applicable to human patients, and application to one case"
511:
is affected. The occurance and attemps of preventing this issue has been adressed many times, but still without complete understanding .
725:
is used for type II (anaphylactic) reactions. For type III reactions, heparin is redosed and the patient may need to go back on bypass.
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2571:
2667:
2027:
Kirklin/Barratt-Boyes cardiac surgery : morphology, diagnostic criteria, natural history, techniques, results, and indications
1785:
Kirklin/Barratt-Boyes cardiac surgery : morphology, diagnostic criteria, natural history, techniques, results, and indications
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200:
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The cannulation strategy varies on several operation-specific and patient-specific details. Nonetheless, a surgeon will place a
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reaction during anticoagulation reversal. There are three types of protamine reactions, and each may cause life-threatening
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probe may be used to help identify aortic calcifications that could potentially become dislodged and cause an occlusion or
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316:
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are potentially life-threatening conditions associated with the administration of heparin. In both of these conditions,
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Al-Atassi, Talal; Toeg, Hadi D.; Chan, Vincent; Ruel, Marc (2016). "Coronary Artery Bypass
Grafting". In Frank Sellke;
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can occur in three to four minutes – death may follow. Similarly, CPB can be used to rewarm individuals who have
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3178:
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1910:
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385:
348:
299:. This rewarming method of using CPB is successful if the core temperature of the patient is above 16 °C.
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54:
45:
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1179:. For retrograde cardioplegia, an incision is made on the posterior (back) surface of the heart through the
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Shore-Lesserson L, Baker RA, Ferraris VA, Greilich PE, Fitzgerald D, Roman P, Hammon JW (February 2018).
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332:, lung trauma from infections, and a range of other problems that impair cardiac or pulmonary function.
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3719:
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The first successful open heart procedure on a human utilizing the heart lung machine was performed by
1298:
The first successful mechanical support of left ventricular function was performed on July 3, 1952, by
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Once the patient is ready to come off of bypass support, the cross-clamp and cannulas are removed and
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Reichman RT, Joyo CI, Dembitsky WP, Griffith LD, Adamson RM, Daily PO, et al. (January 1990).
1969:
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1637:"Prenatal diagnosis of persistent left superior vena cava and its associated congenital anomalies"
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Casazza F, Roncon L, Greco F (Oct 2005). "Pulmonary embolism: treatment of the acute episode".
1321:. Gibbon's machine was further developed into a reliable instrument by a surgical team led by
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1160:
1140:
702:
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445:
39:
2233:"U of U Health - Celebrating 60 Years of Cardiac Surgery in Utah With Russell M. Nelson, M.D."
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Dennis C, Spreng DS, Nelson GE, Karlson KE, Nelson RM, Thomas JV, et al. (October 1951).
1588:"Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass"
705:(type III). Patients with prior exposure to protamine, such as those who have had a previous
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3088:
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1239:
419:
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2060:"High versus low blood pressure targets for cardiac surgery while on cardiopulmonary bypass"
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1183:. The cannula is placed in this incision, passed through the tricuspid valve, and into the
411:
377:
1271:(including Eric Charles, a chemical engineer) were among the pioneers of this technology.
8:
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3546:
3498:
3137:
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2801:
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2613:
1870:"Serious anaphylactic reactions due to protamine sulfate: a systematic literature review"
1346:
1310:
1261:, which was used in experiments with dogs, some of which were showcased in the 1940 film
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cooling the blood in the circuit. All components of the circuit are coated internally by
683:
396:
329:
264:
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by maintaining the circulation of blood and oxygen throughout the body. As such it is an
27:
Technique that temporarily takes over the function of the heart and lungs during surgery
3120:
3033:
3029:
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2970:
2911:
2832:
2740:
2689:
2603:
2412:"Improved patient survival after cardiac arrest using a cardiopulmonary support system"
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2157:
2133:
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cannulation is performed similarly to arterial cannulation. Since calcification of the
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320:
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constructed an early prototype of a heart-lung machine in 1885. This was conducted at
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2005:
1973:
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For four years work was undertaken to improve the machine, and on April 5, 1951, Dr.
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64:
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Berg C, Knüppel M, Geipel A, Kohl T, Krapp M, Knöpfle G, et al. (March 2006).
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The components of the CPB circuit are interconnected by a series of tubes made of
239:
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3235:
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1604:
1587:
1322:
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1222:
1180:
1136:
1119:. Once the cannulation site has been deemed safe, two concentric, diamond-shaped
966:
774:
430:
362:
101:
82:
2109:"The heart-lung machine was invented twice—the first time by Max von Frey"
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2715:
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2497:
Multimedia Manual of
Cardiothoracic Surgery. Cardiopulmonary bypass collection.
1514:
1349:
introduce a gas-permeable membrane between blood and oxygen that decreases the
1226:
Cardiopulmonary bypass machine used at the
University of Michigan in the 1960s.
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953:
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746:
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718:
366:
155:
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3279:
2999:
2618:
2044:
1977:
1842:
1802:
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cannula delivers a
Cardioplegia solution to cause the heart to stop beating.
814:
The pump console usually comprises several rotating, motor-driven pumps that
2391:
1855:
1295:(the third carried out in that year) in November 1951 which was successful.
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893:
851:
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358:
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292:
283:, a state in which the body can be maintained for up to 45 minutes without
263:
Operations requiring the opening of the chambers of the heart, for example
257:
162:
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developed a heart-lung machine for total body perfusion in 1926 named the
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1326:
1303:
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sutures are placed in the distal ascending aorta. A stab incision with a
815:
737:
Cardiopulmonary bypass devices consist of two main functional units: the
714:
698:
694:
482:
474:
296:
1306:. The machine was later used to support the right ventricular function.
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2988:
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2486:
1337:
1112:
943:
835:
742:
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260:, due to the degree of the difficulty of operating on a beating heart.
2338:." (April 23, 2004) University of Alabama at Birmingham. press release
113:
1653:
1636:
803:
706:
653:
426:
284:
2348:
Lim MW (October 2006). "The history of extracorporeal oxygenators".
1544:
178:
3397:
3309:
1438:
Pulmonary
Circulation: Diseases and Their Treatment, Fourth Edition
1350:
1242:. However, such machines were not feasible before the discovery of
1198:
is administered to reverse the anticoagulative effects of heparin.
710:
478:
470:
2511:
credited with the first attempt at cardiopulmonary bypass surgery.
1034:. Other types of solutions act by inhibiting calcium's actions on
1436:. In Peacock, Andrew J.; Naeije, Robert; Rubin, Lewis J. (eds.).
1243:
1124:
1093:
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or another anticoagulant to prevent clotting within the circuit.
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90:
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336:
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922:
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143:
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is a machine that temporarily takes over the function of the
2544:
3451:
1292:
1187:. The cardioplegia lines are connected to the CPB machine.
1155:
1151:
985:
738:
147:
2155:
2057:
1911:"Pumphead: Does the heart-lung machine have a dark side?"
778:
2463:. New York: McGraw-Hill. pp. 317–38. Archived from
820:
This action gently propels the blood through the tubing.
342:
339:, and other conditions may not be candidates for ECMO.
1302:
using a machine co-developed with
General Motors, the
689:
The most common complication associated with CPB is a
488:
A small percentage of patients, such as those with an
311:
2487:
International
Consortium For Evidence-Based Perfusion
1634:
1402:
2390:
1492:(2nd ed.). Fort Myers, Florida: perfusion.com.
1291:), and he performed the first open heart surgery in
2336:
John
Kirklin Cardiac Surgery Pioneer Dead at Age 86
1159:(dual-stage cannulation), it is passed through the
1135:. Other sites for arterial cannulation include the
1874:Basic & Clinical Pharmacology & Toxicology
1460:
822:This is commonly referred to as a roller pump, or
764:Perfusionist operating a modern heart lung machine
520:Potential complications of cardiopulmonary bypass
2029:(4th ed.). Philadelphia: Elsevier/Saunders.
2024:
1787:(4th ed.). Philadelphia: Elsevier/Saunders.
1782:
1373:
603:Dislodging of cannula (causing massive bleeding)
287:(blood flow). If blood flow is stopped at normal
3701:
2210:. Bonnier Corporation. 1 February 1951. p.
1340:was first conceptualized in the 17th century by
1170:If the heart must be stopped for the operation,
279:CPB can be used for the induction of total body
3361:
2457:"Extracorporeal Circulation: Perfusion Systems"
1999:
1585:
1512:
1313:and Frank F. Allbritten Jr. on May 6, 1953, at
1289:The Church of Jesus Christ of Latter-day Saints
1107:The arterial cannulation site is inspected for
749:is used to control body temperature by heating
721:are used for all types of protamine reactions.
467:heparin-induced thrombocytopenia and thrombosis
1030:in the heart, which prevent conduction of the
247:) the pump, the oxygenator, and the reservoir.
3325:
2530:
2454:
1111:or other disease. Preoperative imaging or an
2265:Surgery: Basic science and clinical evidence
1083:
455:Contraindications and special considerations
1167:may also be cannulated in select patients.
207:. Unsourced material may be challenged and
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2572:Cardiology diagnostic tests and procedures
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2523:
1867:
1858:United Press International. April 3, 2008.
1743:: CS1 maint: location missing publisher (
514:
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2668:Transcatheter pulmonary valve replacement
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1641:Ultrasound in Obstetrics & Gynecology
1603:
1562:
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1409:Sabiston and Spencer Surgery of the Chest
1382:. Switzerland: Springer. pp. 93–99.
1046:
353:Cardiac valve repair and/or replacement (
227:Learn how and when to remove this message
2711:shunt from heart chamber to blood vessel
2341:
1481:
1221:
1205:
1150:Aside from the differences in location,
759:
473:against heparin are formed which causes
238:
44:A heart–lung machine (upper right) in a
2811:shunt from blood vessel to blood vessel
2293:
2064:Cochrane Database of Systematic Reviews
1963:
1706:
1704:
1702:
1700:
1264:Experiments in the Revival of Organisms
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14:
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2106:
1966:Cardiopulmonary bypass : a primer
1930:"Cardiopulmonary bypass machine - CPB"
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1280:University of Minnesota Medical Center
1210:A heart lung machine used in London's
899:Some commonly used cannulation sites:
319:(ECMO) is a simplified version of the
3313:
2941:Valve-sparing aortic root replacement
2680:enlargement of existing septal defect
2518:
2002:TSRA Primer of Cardiothoracic Surgery
1995:
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1951:
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1825:Tsra review of cardiothoracic surgery
1822:
1818:
1816:
1814:
1812:
1778:
1776:
1774:
1772:
1770:
1768:
1766:
1764:
1434:"50. Pulmonary Thromboendarterectomy"
709:(protamine is contained in sperm) or
3339:
2675:production of septal defect in heart
2509:. U.S. National Library of Medicine.
1856:Man survives 16 days without a heart
1710:
1315:Thomas Jefferson University Hospital
343:When is cardiopulmonary bypass used?
205:adding citations to reliable sources
172:
3530:Extracorporeal membrane oxygenation
2347:
2018:
1677:
1586:Finley A, Greenberg C (June 2013).
789:
615:Acute respiratory distress syndrome
317:Extracorporeal membrane oxygenation
312:Extracorporeal membrane oxygenation
24:
3525:Isolated organ perfusion technique
2772:transposition of the great vessels
2697:creation of septal defect in heart
2447:
2025:Kouchoukos NT, Kirklin JW (2013).
1984:
1946:
1927:
1809:
1783:Kouchoukos NT, Kirklin JW (2013).
1761:
1238:'s Physiological Institute of the
857:
497:persistent left superior vena cava
401:transposition of the great vessels
25:
3736:
3072:Cardiac resynchronization therapy
2480:
2459:. In Cohn LH, Edmunds LH (eds.).
1868:Nybo M, Madsen JS (August 2008).
1380:Cardiac Surgery: A Complete Guide
1376:"9. Adult cardiopulmonary bypass"
1287:, (who later became president of
1230:The Austrian-German physiologist
3296:
3295:
2362:10.1111/j.1365-2044.2006.04781.x
2174:10.1097/00000658-195110000-00017
2000:Youssef SJ, Williams JA (2013).
1887:10.1111/j.1742-7843.2008.00274.x
1564:10.1016/j.athoracsur.2017.09.061
1490:The Manual of Clinical Perfusion
1374:Stefanou D, Dimarakis I (2020).
463:Heparin-induced thrombocytopenia
177:
3588:Digital subtraction angiography
3079:Left atrial appendage occlusion
2403:
2384:
2328:
2287:
2254:
2225:
2198:
2100:
2051:
1921:
1902:
1861:
1849:
1751:
1513:Ismail A, Miskolczi SY (2019),
1006:
794:Many CPB circuits now employ a
441:Pulmonary thromboendarterectomy
302:
254:coronary artery bypass grafting
3613:Magnetic resonance angiography
2455:Hessel EA, Edmunds LH (2003).
2416:The Annals of Thoracic Surgery
2076:10.1002/14651858.CD013494.pub2
1628:
1579:
1551:The Annals of Thoracic Surgery
1538:
1506:
1454:
1396:
1267:. A team of scientists at the
1246:in 1916, which prevents blood
809:
592:Massive systemic gas embolism
386:atrioventricular septal defect
349:Coronary artery bypass surgery
274:
46:coronary artery bypass surgery
13:
1:
3684:Ankle–brachial pressure index
3201:Radionuclide ventriculography
2300:Texas Heart Institute Journal
2221:– via Internet Archive.
1361:
829:
732:
3494:Endovascular aneurysm repair
3186:Myocardial perfusion imaging
2503:"The Clarence Dennis Papers"
2461:Cardiac Surgery in the Adult
2429:10.1016/0003-4975(90)90363-B
2107:Zimmer HG (September 2003).
1715:(Fifth ed.). New York.
1713:Cardiac surgery in the adult
1605:10.1213/ANE.0b013e31827e4e62
1041:
876:determined by the patient's
391:Repair and/or palliation of
7:
1432:Madani, Michael M. (2016).
866:
713:(protamine is contained in
490:antithrombin III deficiency
10:
3741:
2793:for univentricular defect
2004:. Chicago, IL: TSRA/TSDA.
1909:Stutz B (9 January 2009).
1440:. CRC Press. p. 541.
1201:
1100:is administered until the
1010:
715:neutral protamine hagedorn
416:heart–lung transplantation
3671:
3646:
3623:
3578:
3569:
3507:
3479:
3446:
3413:
3347:
3293:
3272:
3244:
3133:Implantable loop recorder
3101:
2956:
2852:
2777:Arterial switch operation
2592:
2585:
2567:Interventional cardiology
2557:
2269:. NY: springer. pp.
1521:, StatPearls Publishing,
1084:Intra-operative technique
768:
382:ventricular septal defect
110:
99:
89:
75:
63:
53:
37:
32:
3654:Intravascular ultrasound
3608:Radionuclide angiography
3212:Coronary catheterization
2702:Blalock–Hanlon procedure
2663:Mitral valve replacement
2646:Aortic valve replacement
1970:University of Washington
1592:Anesthesia and Analgesia
1515:"Cardiopulmonary Bypass"
1488:Lich B, Brown M (2004).
1269:University of Birmingham
784:
393:congenital heart defects
3659:Carotid ultrasonography
3603:Fluorescein angiography
3208:Cardiac catheterization
3150:Electrophysiology study
3050:Radiofrequency ablation
3015:Alcohol septal ablation
1102:activated clotting time
641:Capillary leak syndrome
515:Risks and complications
509:cerebral autoregulation
450:Isolated Limb perfusion
168:
3638:Impedance phlebography
3515:Cardiopulmonary bypass
3423:Ambulatory phlebectomy
3391:Carotid endarterectomy
3254:Impedance cardiography
2876:Coronary artery bypass
2125:10.1002/clc.4960260914
1711:Cohn LH (2017-08-28).
1411:. pp. 1553–1554.
1227:
1219:
1216:Science Museum, London
1161:right atrial appendage
1141:brachiocephalic artery
1104:is above 480 seconds.
1047:Pre-operative planning
984:Bypass grafts (during
956:(retrograde delivery)
818:"massage" the tubing.
765:
703:pulmonary hypertension
667:Postperfusion syndrome
446:Pulmonary thrombectomy
248:
124:Cardiopulmonary bypass
33:Cardiopulmonary bypass
3285:Transcutaneous pacing
3089:Heart transplantation
3010:Ventricular reduction
2826:Blalock–Taussig shunt
1253:The Soviet scientist
1240:University of Leipzig
1225:
1209:
886:anticipated flow rate
763:
477:and the formation of
425:Repair of some large
420:liver transplantation
408:heart transplantation
256:(CABG), the heart is
242:
161:CPB is operated by a
156:extracorporeal device
3593:Cerebral angiography
3354:Endovascular surgery
3259:Ballistocardiography
2816:systemic circulation
1378:. In Raja SG (ed.).
1347:Membrane oxygenators
1331:Rochester, Minnesota
1300:Forest Dewey Dodrill
1278:led the team at the
1071:Cannulation strategy
1028:fast sodium currents
892:being cannulated. A
412:lung transplantation
378:atrial septal defect
201:improve this section
3715:American inventions
3552:Seldinger technique
3547:First rib resection
3499:Open aortic surgery
3138:Cardiac stress test
3116:Electrocardiography
3055:Pacemaker insertion
2802:Kawashima procedure
2766:compound procedures
2641:Aortic valve repair
2614:Mitral valve repair
2507:Profiles in Science
2294:Hedlund KD (2001).
2113:Clinical Cardiology
1964:Mokadam NA (2015).
1915:Scientific American
1232:Maximilian von Frey
863:cardioplegia line.
838:is designed to add
684:membrane oxygenator
521:
475:platelet activation
397:Tetralogy of Fallot
330:pulmonary embolisms
265:mitral valve repair
3191:Cardiovascular MRI
3121:Vectorcardiography
2976:Pericardial window
2971:Pericardiocentesis
2912:Drug-eluting stent
2741:Rastelli procedure
2690:Balloon septostomy
2242:on 17 January 2018
1333:in the mid-1950s.
1255:Sergei Brukhonenko
1228:
1220:
1212:Middlesex Hospital
935:, proximal to the
890:size of the vessel
766:
541:Protamine reaction
519:
435:cerebral aneurysms
321:heart lung machine
249:
245:from top to bottom
152:open-heart surgery
132:heart-lung machine
18:Heart–lung machine
3725:Soviet inventions
3720:German inventions
3710:Medical equipment
3697:
3696:
3667:
3666:
3565:
3564:
3542:Revascularization
3307:
3306:
3164:Angiocardiography
3110:Electrophysiology
3097:
3096:
3040:Catheter ablation
3023:Conduction system
2948:LeCompte maneuver
2936:Bentall procedure
2797:Norwood procedure
2787:Senning procedure
2782:Mustard procedure
2685:Atrial septostomy
2636:Valve replacement
2280:978-0-387-30800-5
2261:Norton J (2008).
2162:Annals of Surgery
2036:978-1-4557-4605-7
2011:978-0-9894023-0-9
1834:978-1-5232-1716-8
1827:. : Createspace.
1823:Lapar DJ (2016).
1794:978-1-4557-4605-7
1722:978-0-07-184487-1
1499:978-0-9753396-0-2
1447:978-1-4987-1991-9
1418:978-0-323-24126-7
1405:Pedro J. del Nido
1389:978-3-030-24176-6
1285:Russell M. Nelson
1196:protamine sulfate
1177:coronary arteries
1129:aortic dissection
1004:
1003:
800:centrifugal force
679:
678:
567:Aortic dissection
533:Death or serious
406:Transplantation (
237:
236:
229:
121:
120:
91:OPS-301 code
16:(Redirected from
3732:
3672:Other diagnostic
3576:
3575:
3403:Carotid stenting
3363:Arterial disease
3359:
3358:
3341:Vascular surgery
3334:
3327:
3320:
3311:
3310:
3299:
3298:
3264:Cardiotocography
3232:
3196:Ventriculography
3169:Echocardiography
3160:
3112:
3028:Maze procedure (
3025:
2991:
2967:
2920:
2919:Obstacle removal
2907:Bare-metal stent
2903:
2863:
2820:pulmonary artery
2812:
2767:
2752:pulmonary artery
2725:Fontan procedure
2720:pulmonary artery
2712:
2676:
2590:
2589:
2539:
2532:
2525:
2516:
2515:
2510:
2475:
2473:
2472:
2442:
2441:
2431:
2407:
2401:
2400:
2399:
2395:
2388:
2382:
2381:
2345:
2339:
2332:
2326:
2325:
2315:
2291:
2285:
2284:
2268:
2258:
2252:
2251:
2249:
2247:
2238:. Archived from
2229:
2223:
2222:
2220:
2218:
2202:
2196:
2195:
2185:
2153:
2147:
2146:
2136:
2104:
2098:
2097:
2087:
2055:
2049:
2048:
2022:
2016:
2015:
1997:
1982:
1981:
1961:
1944:
1943:
1941:
1940:
1925:
1919:
1918:
1906:
1900:
1899:
1889:
1865:
1859:
1853:
1847:
1846:
1820:
1807:
1806:
1780:
1759:
1755:
1749:
1748:
1742:
1734:
1708:
1675:
1674:
1656:
1654:10.1002/uog.2704
1632:
1626:
1625:
1607:
1598:(6): 1210–1222.
1583:
1577:
1576:
1566:
1542:
1536:
1535:
1534:
1533:
1510:
1504:
1503:
1485:
1479:
1478:
1458:
1452:
1451:
1429:
1423:
1422:
1400:
1394:
1393:
1371:
1057:anesthesiologist
1032:action potential
925:, distal to the
902:
901:
846:and remove some
824:peristaltic pump
796:centrifugal pump
790:Centrifugal pump
522:
518:
431:aortic aneurysms
372:Repair of large
325:centrifugal pump
323:that includes a
289:body temperature
232:
225:
221:
218:
212:
181:
173:
114:edit on Wikidata
85:
42:
30:
29:
21:
3740:
3739:
3735:
3734:
3733:
3731:
3730:
3729:
3700:
3699:
3698:
3693:
3663:
3642:
3619:
3571:Medical imaging
3561:
3537:Vascular access
3503:
3481:Aortic aneurysm
3475:
3442:
3409:
3371:Vascular bypass
3352:
3343:
3338:
3308:
3303:
3289:
3268:
3240:
3236:Phonocardiogram
3228:
3158:Cardiac imaging
3156:
3108:
3093:
3021:
3005:Septal myectomy
2995:Cardiomyoplasty
2987:
2981:Pericardiectomy
2963:
2952:
2918:
2899:
2859:
2853:Cardiac vessels
2848:
2842:Glenn procedure
2810:
2765:
2748:right ventricle
2710:
2674:
2596:
2581:
2577:Cardiac imaging
2562:Cardiac surgery
2553:
2543:
2501:
2483:
2478:
2470:
2468:
2450:
2448:Further reading
2445:
2408:
2404:
2397:
2389:
2385:
2356:(10): 984–995.
2346:
2342:
2333:
2329:
2292:
2288:
2281:
2259:
2255:
2245:
2243:
2231:
2230:
2226:
2216:
2214:
2207:Popular Science
2204:
2203:
2199:
2154:
2150:
2105:
2101:
2056:
2052:
2037:
2023:
2019:
2012:
1998:
1985:
1962:
1947:
1938:
1936:
1926:
1922:
1907:
1903:
1866:
1862:
1854:
1850:
1835:
1821:
1810:
1795:
1781:
1762:
1756:
1752:
1736:
1735:
1723:
1709:
1678:
1633:
1629:
1584:
1580:
1543:
1539:
1531:
1529:
1511:
1507:
1500:
1486:
1482:
1459:
1455:
1448:
1430:
1426:
1419:
1401:
1397:
1390:
1372:
1368:
1364:
1323:John W. Kirklin
1276:Clarence Dennis
1204:
1181:right ventricle
1137:axillary artery
1086:
1073:
1049:
1044:
1015:
1009:
971:Coronary ostia
967:Axillary artery
869:
860:
858:Heat exchangers
832:
816:peristaltically
812:
792:
787:
775:silicone rubber
771:
735:
719:Corticosteroids
534:
529:
517:
457:
363:tricuspid valve
345:
314:
305:
277:
233:
222:
216:
213:
198:
182:
171:
117:
81:
49:
28:
23:
22:
15:
12:
11:
5:
3738:
3728:
3727:
3722:
3717:
3712:
3695:
3694:
3692:
3691:
3686:
3681:
3675:
3673:
3669:
3668:
3665:
3664:
3662:
3661:
3656:
3650:
3648:
3644:
3643:
3641:
3640:
3635:
3629:
3627:
3621:
3620:
3618:
3617:
3616:
3615:
3610:
3605:
3600:
3595:
3584:
3582:
3573:
3567:
3566:
3563:
3562:
3560:
3559:
3557:Vascular snare
3554:
3549:
3544:
3539:
3534:
3533:
3532:
3522:
3517:
3511:
3509:
3505:
3504:
3502:
3501:
3496:
3490:
3488:
3477:
3476:
3474:
3473:
3468:
3463:
3461:Venous cutdown
3457:
3455:
3444:
3443:
3441:
3440:
3438:Vein stripping
3435:
3430:
3425:
3419:
3417:
3415:Venous disease
3411:
3410:
3408:
3407:
3406:
3405:
3395:
3394:
3393:
3386:Endarterectomy
3383:
3378:
3373:
3367:
3365:
3356:
3345:
3344:
3337:
3336:
3329:
3322:
3314:
3305:
3304:
3294:
3291:
3290:
3288:
3287:
3282:
3276:
3274:
3270:
3269:
3267:
3266:
3261:
3256:
3250:
3248:
3246:Function tests
3242:
3241:
3239:
3238:
3233:
3225:
3224:
3219:
3214:
3205:
3204:
3203:
3193:
3188:
3183:
3182:
3181:
3176:
3166:
3161:
3153:
3152:
3147:
3146:
3145:
3143:Bruce protocol
3135:
3130:
3128:Holter monitor
3125:
3124:
3123:
3113:
3105:
3103:
3099:
3098:
3095:
3094:
3092:
3091:
3086:
3081:
3075:
3074:
3069:
3063:
3057:
3052:
3047:
3042:
3037:
3026:
3018:
3017:
3012:
3007:
3002:
2997:
2992:
2984:
2983:
2978:
2973:
2968:
2960:
2958:
2954:
2953:
2951:
2950:
2944:
2943:
2938:
2932:
2931:
2926:
2924:Endarterectomy
2921:
2915:
2914:
2909:
2904:
2901:Coronary stent
2896:
2895:
2894:
2893:
2888:
2883:
2869:
2864:
2856:
2854:
2850:
2849:
2847:
2846:
2845:
2844:
2830:
2829:
2828:
2813:
2807:
2806:
2805:
2804:
2799:
2791:
2790:
2789:
2784:
2779:
2768:
2762:
2761:
2760:
2759:
2745:
2744:
2743:
2732:left ventricle
2729:
2728:
2727:
2713:
2707:
2706:
2705:
2704:
2694:
2693:
2692:
2687:
2677:
2671:
2670:
2665:
2660:
2659:
2658:
2653:
2651:Ross procedure
2643:
2638:
2633:
2632:
2631:
2626:
2616:
2611:
2606:
2600:
2598:
2587:
2583:
2582:
2580:
2579:
2574:
2569:
2564:
2558:
2555:
2554:
2549:involving the
2542:
2541:
2534:
2527:
2519:
2513:
2512:
2499:
2494:
2489:
2482:
2481:External links
2479:
2477:
2476:
2451:
2449:
2446:
2444:
2443:
2422:(1): 101–105.
2402:
2383:
2340:
2327:
2306:(4): 292–296.
2286:
2279:
2253:
2224:
2197:
2168:(4): 709–721.
2148:
2119:(9): 443–445.
2099:
2050:
2035:
2017:
2010:
1983:
1945:
1934:www.ebme.co.uk
1920:
1901:
1880:(2): 192–196.
1860:
1848:
1833:
1808:
1793:
1760:
1750:
1721:
1676:
1647:(3): 274–280.
1627:
1578:
1557:(2): 650–662.
1537:
1505:
1498:
1480:
1469:(10): 818–23.
1453:
1446:
1424:
1417:
1395:
1388:
1365:
1363:
1360:
1203:
1200:
1185:coronary sinus
1145:femoral artery
1085:
1082:
1072:
1069:
1048:
1045:
1043:
1040:
1011:Main article:
1008:
1005:
1002:
1001:
999:
993:
990:
989:
982:
976:
973:
972:
969:
964:
958:
957:
954:Coronary sinus
951:
949:Femoral artery
946:
940:
939:
929:
919:
913:
912:
909:
906:
868:
865:
859:
856:
848:carbon dioxide
831:
828:
811:
808:
791:
788:
786:
783:
770:
767:
747:heat exchanger
734:
731:
723:Chlorphenamine
701:(type II), or
677:
676:
673:
670:
663:
662:
659:
656:
650:
649:
646:
643:
637:
636:
633:
630:
624:
623:
620:
617:
611:
610:
607:
604:
600:
599:
596:
593:
589:
588:
585:
582:
576:
575:
572:
569:
563:
562:
559:
556:
550:
549:
546:
543:
537:
536:
531:
530:(events/1000)
526:
516:
513:
456:
453:
452:
451:
448:
443:
438:
423:
404:
389:
370:
367:pulmonic valve
351:
344:
341:
313:
310:
304:
301:
276:
273:
235:
234:
185:
183:
176:
170:
167:
119:
118:
111:
108:
107:
104:
97:
96:
93:
87:
86:
79:
73:
72:
67:
61:
60:
57:
51:
50:
43:
35:
34:
26:
9:
6:
4:
3:
2:
3737:
3726:
3723:
3721:
3718:
3716:
3713:
3711:
3708:
3707:
3705:
3690:
3687:
3685:
3682:
3680:
3677:
3676:
3674:
3670:
3660:
3657:
3655:
3652:
3651:
3649:
3645:
3639:
3636:
3634:
3631:
3630:
3628:
3626:
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3459:
3458:
3456:
3453:
3449:
3445:
3439:
3436:
3434:
3433:Sclerotherapy
3431:
3429:
3428:Laser surgery
3426:
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3421:
3420:
3418:
3416:
3412:
3404:
3401:
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3280:Cardioversion
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3006:
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3000:Dor procedure
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2840:
2839:
2838:
2835:to the right
2834:
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2657:
2656:Transcatheter
2654:
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2644:
2642:
2639:
2637:
2634:
2630:
2627:
2625:
2622:
2621:
2620:
2619:Valvuloplasty
2617:
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2607:
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2485:
2484:
2467:on 2006-12-10
2466:
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2077:
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2061:
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2013:
2007:
2003:
1996:
1994:
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1990:
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1971:
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1199:
1197:
1192:
1188:
1186:
1182:
1178:
1173:
1168:
1166:
1162:
1157:
1156:venous system
1153:
1148:
1146:
1142:
1138:
1134:
1130:
1126:
1122:
1118:
1114:
1110:
1109:calcification
1105:
1103:
1099:
1098:anticoagulant
1095:
1091:
1081:
1078:
1068:
1066:
1065:nursing staff
1062:
1058:
1054:
1039:
1037:
1033:
1029:
1025:
1021:
1014:
1000:
998:
994:
992:
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987:
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945:
942:
941:
938:
934:
930:
928:
924:
920:
918:
915:
914:
911:Cardioplegia
910:
907:
904:
903:
900:
897:
895:
891:
887:
883:
879:
874:
864:
855:
853:
849:
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837:
827:
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821:
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797:
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762:
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748:
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730:
726:
724:
720:
716:
712:
708:
704:
700:
696:
692:
687:
685:
674:
671:
669:("pumphead")
668:
665:
664:
660:
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651:
647:
644:
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551:
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544:
542:
539:
538:
532:
527:
525:Complication
524:
523:
512:
510:
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503:
498:
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486:
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206:
202:
196:
195:
191:
186:This section
184:
180:
175:
174:
166:
164:
159:
157:
153:
149:
145:
141:
137:
133:
129:
125:
115:
109:
105:
103:
98:
94:
92:
88:
84:
80:
78:
74:
71:
68:
66:
62:
58:
56:
52:
47:
41:
36:
31:
19:
3689:Toe pressure
3520:Cardioplegia
3514:
3068:implantation
3062:implantation
3045:Cryoablation
2886:Off-pump CAB
2696:
2679:
2604:Valve repair
2594:Heart valves
2506:
2469:. Retrieved
2465:the original
2460:
2419:
2415:
2405:
2386:
2353:
2349:
2343:
2330:
2303:
2299:
2289:
2264:
2256:
2244:. Retrieved
2240:the original
2235:
2227:
2215:. Retrieved
2206:
2200:
2165:
2161:
2151:
2116:
2112:
2102:
2067:
2063:
2053:
2026:
2020:
2001:
1965:
1937:. Retrieved
1933:
1923:
1914:
1904:
1877:
1873:
1863:
1851:
1824:
1784:
1753:
1712:
1644:
1640:
1630:
1595:
1591:
1581:
1554:
1550:
1540:
1530:, retrieved
1518:
1508:
1489:
1483:
1466:
1463:Ital Heart J
1462:
1456:
1437:
1427:
1408:
1398:
1379:
1369:
1356:
1351:blood trauma
1342:Robert Hooke
1335:
1319:Philadelphia
1308:
1297:
1273:
1262:
1258:
1252:
1229:
1193:
1189:
1172:cardioplegia
1169:
1165:femoral vein
1149:
1133:air embolism
1106:
1087:
1074:
1061:perfusionist
1050:
1023:
1019:
1016:
1013:Cardioplegia
1007:Cardioplegia
995:Apex of the
962:Femoral vein
917:Right atrium
898:
894:Cardioplegia
889:
885:
881:
877:
870:
861:
852:venous blood
833:
819:
813:
793:
772:
750:
736:
727:
688:
680:
580:Gas embolism
506:
502:cardioplegia
494:
487:
461:
458:
359:mitral valve
355:aortic valve
334:
315:
306:
303:Cooled blood
293:brain damage
291:, permanent
278:
262:
250:
244:
223:
214:
199:Please help
187:
163:perfusionist
160:
139:
135:
134:also called
131:
127:
123:
122:
3633:Portography
3598:Aortography
3580:Angiography
3466:Arteriotomy
3381:Atherectomy
3376:Angioplasty
3222:Cardiac PET
2965:Pericardium
2929:Atherectomy
2867:Angioplasty
2609:Valvulotomy
2350:Anaesthesia
1758:PMC10026164
1327:Mayo Clinic
1311:John Gibbon
1304:Dodrill-GMR
1248:coagulation
1236:Carl Ludwig
1121:pursestring
1096:or another
1090:crystalloid
937:cross-clamp
927:cross-clamp
842:to infused
810:Roller pump
699:anaphylaxis
695:hypotension
535:injury (%)
483:Bivalirudin
479:blood clots
297:hypothermia
281:hypothermia
275:Hypothermia
269:replacement
3704:Categories
3679:Angioscopy
3647:Ultrasound
3625:Venography
3485:dissection
3471:Phlebotomy
3217:Cardiac CT
3084:Cardiotomy
2989:Myocardium
2757:Sano shunt
2547:procedures
2545:Tests and
2471:2006-12-09
2392:US 4540399
1939:2019-11-21
1928:Davies H.
1532:2020-01-21
1519:StatPearls
1362:References
1338:oxygenator
1259:Autojektor
1113:ultrasound
1024:retrograde
944:Vena cavae
888:, and the
836:oxygenator
830:Oxygenator
743:oxygenator
733:Components
697:(type I),
628:Arrythmias
595:0.03–0.07
574:14.3–33.1
554:Thrombosis
528:Incidence
471:antibodies
55:ICD-10-PCS
2597:and septa
2045:812289395
1978:922073684
1843:953497320
1803:812289395
1739:cite book
1731:930496902
1214:in 1958.
1042:Technique
1020:antegrade
931:Proximal
921:Proximal
908:Arterial
871:Multiple
850:from the
806:, etc.).
804:hemolysis
711:diabetics
707:vasectomy
691:protamine
654:Hemolysis
427:aneurysms
376:defects (
285:perfusion
217:June 2024
188:does not
3448:Arterial
3398:Stenting
3349:Vascular
3301:Category
3034:minimaze
3030:Cox maze
2378:24970815
2370:16978315
2322:11777154
2236:utah.edu
2192:14878382
2143:14524605
2094:36448514
1896:18816305
1671:26364072
1663:16456841
1622:22500786
1614:23408671
1573:29362176
1527:29489210
1475:16270473
1407:(eds.).
1036:myocytes
873:cannulae
867:Cannulae
741:and the
609:4.2–7.1
606:0.2–1.6
587:0.2–8.7
584:0.2–1.3
571:0.4–0.8
561:2.6–5.2
558:0.3–0.4
258:arrested
140:CPB pump
136:the pump
106:22570829
65:ICD-9-CM
2586:Surgery
2438:2297254
2246:4 April
2217:4 April
2183:1802968
2134:6654655
2085:9709767
1325:at the
1244:heparin
1218:(2008)
1202:History
1125:scalpel
1094:heparin
1077:cannula
1053:surgeon
978:Distal
905:Venous
755:heparin
209:removed
194:sources
150:during
83:D002318
3454:access
3452:venous
3273:Pacing
2881:MIDCAB
2872:Bypass
2822:shunt
2716:atrium
2629:mitral
2624:aortic
2436:
2398:
2376:
2368:
2320:
2313:101205
2310:
2277:
2190:
2180:
2141:
2131:
2092:
2082:
2070:(11).
2043:
2033:
2008:
1976:
1894:
1841:
1831:
1801:
1791:
1729:
1719:
1669:
1661:
1620:
1612:
1571:
1525:
1496:
1473:
1444:
1415:
1386:
1152:venous
1117:stroke
1063:, and
882:weight
840:oxygen
769:Tubing
598:50–52
374:septal
337:sepsis
100:Other
3508:Other
3230:sound
3102:Tests
3060:S-ICD
2957:Other
2891:TECAB
2736:aorta
2551:heart
2374:S2CID
1667:S2CID
1618:S2CID
1143:, or
997:heart
980:aorta
933:aorta
923:aorta
844:blood
785:Pumps
548:10.5
148:lungs
144:heart
130:) or
112:[
102:codes
70:39.61
3450:and
3351:and
3032:and
2770:for
2434:PMID
2366:PMID
2318:PMID
2275:ISBN
2271:1473
2248:2018
2219:2018
2188:PMID
2139:PMID
2090:PMID
2068:2022
2041:OCLC
2031:ISBN
2006:ISBN
1974:OCLC
1892:PMID
1839:OCLC
1829:ISBN
1799:OCLC
1789:ISBN
1745:link
1727:OCLC
1717:ISBN
1659:PMID
1610:PMID
1569:PMID
1523:PMID
1494:ISBN
1471:PMID
1442:ISBN
1413:ISBN
1384:ISBN
1336:The
1293:Utah
986:CABG
880:and
878:size
834:The
739:pump
545:1.3
465:and
192:any
190:cite
169:Uses
146:and
77:MeSH
3179:TEE
3174:TTE
3066:ICD
2861:CHD
2833:SVC
2818:to
2750:to
2734:to
2718:to
2424:doi
2358:doi
2308:PMC
2178:PMC
2170:doi
2166:134
2129:PMC
2121:doi
2080:PMC
2072:doi
1882:doi
1878:103
1649:doi
1600:doi
1596:116
1559:doi
1555:105
1329:in
1317:in
1022:or
779:PVC
777:or
267:or
203:by
138:or
128:CPB
3706::
3483:/
2837:PA
2505:.
2432:.
2420:49
2418:.
2414:.
2372:.
2364:.
2354:61
2352:.
2316:.
2304:28
2302:.
2298:.
2273:.
2186:.
2176:.
2164:.
2160:.
2137:.
2127:.
2117:26
2115:.
2111:.
2088:.
2078:.
2066:.
2062:.
2039:.
1986:^
1972:.
1968:.
1948:^
1932:.
1913:.
1890:.
1876:.
1872:.
1837:.
1811:^
1797:.
1763:^
1741:}}
1737:{{
1725:.
1679:^
1665:.
1657:.
1645:27
1643:.
1639:.
1616:.
1608:.
1594:.
1590:.
1567:.
1553:.
1549:.
1517:,
1465:.
1250:.
1147:.
1139:,
1067:.
1059:,
1055:,
1038:.
988:)
884:,
854:.
781:.
751:or
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