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Alexis Carrel and Charles Lindbergh were among the most famous international figures in the 20th century: Carrel, the surgeon-scientist who won a Nobel prize as a young surgeon, and Lindbergh, the aviator-engineer who pioneered aviation and promoted commercial flight throughout his life. Surprisingly, these two amazing individuals came together to collaborate on the early development of extracorporeal circulation. Their work was interrupted by the onset of World War II, which destroyed one of them and nearly destroyed the other., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The world's first implantable total artificial heart was designed by Vladimir Demikhov as a fourth year biology student in Voronezh, Soviet Union, in 1937. As a prototype of his device, Demikhov must have used an apparatus for extracorporeal blood circulation invented by Sergei Bryukhonenko of Moscow. The device was the size of a dog's native heart and consisted of two diaphragm pumps brought into motion by an electric motor. A dog with an implanted device lived for 2.5 hours. In addition to having the prototype, the preconditions for Demikhov's artificial heart creation were his manual dexterity, expertise in animal physiology, and his mechanistic worldview.

Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.

Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field., (Copyright © 2012 S. Karger AG, Basel.)

The paper describes and analyzes the initial period in the formation of cardiac resuscitation service at the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, from the first heart operation performed in the USSR to the setting up of the resuscitation-anesthesiology department. On September 24, 1948, A. N. Bakulev was the first in the USSR to make an operation for congenital heart disease, the successful outcome of which predetermined anesthetic maintenance and antishock measures as well. On May 1959, the Institute of Thoracic Surgery, U.S.S.R. Academy of Medical Sciences, began performing heart operations under extracorporeal circulation. The number of postoperative complications has increased due to the higher severity of diseases and the complexity of open heart surgery. This has made the rehabilitative period require that vital function recovery specialists should participate more frequently (Smirenskaya Ye. M.), which ultimately give birth to a resuscitation department in January 1967 (Levant A. D.) and its transformation to a resuscitation-anesthesiology department on October 31, 1973 (Malyshev V. D.).

The article presents data about well-known Russian physician-physiologist and researcher Sergey Sergeeviche Brukhonenko. The hard way passed by the scientist-researcher from completion of artificial breath technique to the method of artificial blood circulation developed by him and development of the first in the world--artificial blood circulation device--autoejector is shown in the article.

Between March 26, 1954 and July 19, 1955, C. Walton Lillehei and colleagues operated upon 45 infants and children with previously uncorrectable cardiac anomalies using cross-circulation with a human donor. Late follow-up was obtained in all of the 28 patients discharged after the operation. All of the 20 currently living patients were personally interviewed with regard to their cardiac status. Eight early survivors have died. Three died after repair of a residual cardiac anomaly. Another died 4 months postoperatively from heart failure. The other 4 died 13 to 47 years later: 2 of unknown causes, 1 of pneumonia, and 1 was an accident. Eleven late cardiac operations were performed. Seven were done to correct a residual anomaly. More than 40 years later, 2 patients underwent procedures to correct tricuspid regurgitation. One had a mitral valve procedure, and another underwent coronary artery bypass grafting. Of the current 20 survivors, none is limited from cardiac causes. Considering that these 45 patients represent "the dawn of open-heart surgery," the long-term results are quite remarkable.

In this year, we commemorate half a century of the first open-heart surgery performed in Mexico at the Military Hospital on January 11, 1957. The surgery was performed in a child with interventricular communication by Dr. Raul Baz; in this surgery a De Wall and Lillehei bubble oxygenator was used. The perfusionist was Dr. Marcelo García Cornejo. The present historical review is aimed at covering the advances in cardiology from its beginnings to the present.

The article summarizes forty-year experience in working over the problem of the artificial heart and auxiliary blood circulation in Laboratory and later Research Institute of Transplantology and Artificial Organs. This work has resulted in the development of balloon pumps for intraaortic contrapulsation, the technique of balloon installation, and indications to its application. The results of the clinical application of the method in patients with various pathologies have been estimated. Preclinically, left ventricular bypass techniques have been tested on more than twenty models of membrane type artificial ventricles. The results of the clinical application of left ventricular bypass have been analyzed. The authors adduce data on the development of the thermomechanical implantable bypass system "Micron-M". After achieving 100-day survival of calves with an artificial heart, an artificial heart with external power supply was used as a "bridge" to heart transplantation, but there was only one patient in whom transplantation was performed. The authors consider development of implantable auxiliary blood circulation devices and the artificial heart to be of great prospective value.

This review recounts the development of extracorporeal life support (ECLS, ECMO) from the laboratory and early clinical trials to routine clinical application. Lessons from neonatal ECMO have led to better understanding of neonatal lung physiology, improved methods of treatment, and application of ECLS to other patient populations.

The development of modern techniques in extracorporeal circulation is the result of the combined efforts of physiologists, physicians, and engineers. Early experimental work at the end of the 19th century was accomplished by physiologists, such as von Schröder, von Frey, and Gruber, as well as Jacobj. These scientists laid the foundation for three different artificial oxygenation devices for experimental isolated animal organ perfusion. The developed bubble, film, and isolated lung oxygenation methods developed were later used for the first clinical cardiopulmonary bypass procedures in humans. For continuous perfusion experiments, closed circulation circuits were put into use. In a second step, during the first half of the 20th century, scientists and physicians, such as Brukhonenko, Gibbon, Crafoord, Björk, and Jongbloed were working on the refinement of these methods for intended application during cardiovascular operations in humans. Refined bubble and film oxygenators together with the modern blood pumps in closed circulatory systems were assembled as pump oxygenators, later called heart-lung machines. They were used in the first clinical cases of extracorporeal circulation for heart surgery in the second half of the 20th century by Dennis, Dogliotti and Constantini, and Gibbon.

The first roller pump was patented in 1855 by Porter and Bradley and was hand operated. A modification first named "surgical pump", designed and manufactured by E. E. Allen in 1887, was intended for direct blood transfusion. Truax, who also distributed and promoted the Allen pump with one roller, developed the first double roller pump in 1899. In the following decades, several researchers, including Beck, Van Allen, Bayliss and Müller as well as Henry and Jouvelet, refined the apparatus and recommended the use of roller pumps for blood transfusion and other applications. After further modifications made by DeBakey in 1934, and application of this pump in one of the first heart-lung machines constructed by Gibbon, DeBakey's name became inseparably attached to this type of pump. For perfusion experiments, an electrically powered roller pump was first used by Fleisch in 1935. Today, the roller pump is the most frequently used blood pump for cardiopulmonary bypass worldwide, having prevailed against the early pulsatile tube compression pumps and ventricular pumps. In recent years, centrifugal pumps have increasingly competed with roller pumps as systemic blood pumps for cardiopulmonary bypass and have become the preferred arterial pump in a variety of centers. Application of mechanical cardiac assistance has evolved from nonpulsatile roller pump support, followed by an era of pulsatile ventricular pumps to the rediscovery of the nonpulsatile flow mode with modern axial flow pumps.

While the techniques and equipment used 50 years ago may seem primitive by today's standards, they did permit cardiac surgery to rapidly develop. As early as 1951, Karlson would write: 'Recent advances in surgery have made operations upon the heart much more than surgical stunts, and have opened a hitherto relatively untouched field of surgical endeavor. A few years later, Mustard would defend his abysmal series of repairs of congenital cardiac defects by saying, 'Our techniques of perfusion and operation have proved feasible in three human cases, but the results are not adequate to operate freely on good-risk patients at the present time. It is hoped that improvements in techniques will soon make this possible'. By the end of the decade of the 1950s. Gross would express the following: In the support of human patients on pump oxygenators, the intricacies of technic are many, and the extent of problems is broad, but much clarity of thought is now evident. We can set forth certain statements considered to represent truths or valuable viewpoints, since in most cases they have derived from scores of laboratory experiences during which some 800 dogs have been used by us, or else they have been crystallized from bitter experience at the operating table, or shattering disappointments in postoperative failures. Fortunately, many of the conclusions have sprung from happy and rewarding results exhibited by patients who have weathered corrective surgery in a very satisfactory manner. In closing, after reviewing the early perfusion literature, it is evident that many techniques used in the 1930s, 1940s, and 1950s persist to the present. Some techniques fell out of favor, such as elective hyperkalemic arrest, only to be re-established decades later. Simplicity is the hallmark of the most enduring techniques, a thought expressed by Lillehei in 1955. Somewhat amazingly, full automation of the extracorporeal circuit existed on some of the very early machines, but perhaps because of the explosive growth of cardiac surgery and the need for disposable circuits that could be rapidly assembled, the safety aspects of heart-lung machines were neglected for many decades. Some would argue it still has not realized its potential for elimination of error in the conduct of cardiopulmonary bypass. However, cardiac surgery would not wait, and in 1956, Osborn would boldly state: 'Extracorporeal circulation for surgery of the heart has now come of age.

On the occasion of the hundredth anniversary of heart surgery, this article presents the remarkable work of the Russian scientist and surgeon Nikolai Terebinski. The medical world today remains largely unaware that he performed the first successful open valve operations. These experimental operations were conducted in Russia between 1926 and 1937 through the use of an extracorporeal circulation device known as the autojector. The experiments were reviewed based on Terebinski's original articles and experimental notes. Here we present the techniques and results of his landmark open valve operations on dogs. He performed more than 250 open valve operations, which were the first of their kind. In his attempt to create and then later correct tricuspid and mitral valve stenosis and insufficiency, Terebinski developed many principles of open heart surgery that are valid today. His work represents a milestone in the history of heart surgery.

The clinical application of hypothermia dates back to the surgical treatment of blue babies (1949) and the early days of open heart surgery (1952), when generalized cooling was employed. The induction of hepatic hypothermia began with whole-body cooling in experimental models in 1953 and clinically in 1961. It was designed to minimize the ischemia-reperfusion injury associated with hepatic inflow occlusion. Body surface cooling and cooling via an extracorporeal circuit, however, were not widely accepted for hepatic surgery because of the adverse effects on the extrahepatic organs. Consequently, with the introduction of improved venovenous bypass techniques, in situ cold hepatic perfusion has been used in selected patients since 1971. In situ hypothermic hemihepatic perfusion, introduced in 1995, prevents an ischemic insult to the contralateral hepatic lobe. Topical cooling using ice slush under total or hemihepatic inflow occlusion was reported in 1993. This technique does not require cumbersome hypothermic perfusion equipment. In attempts to minimize intraoperative bleeding by vascular occlusion, the liver surgeon must consider the benefits and technical demands of hepatic hypothermia.

The paper shows the role of Academician B.V. Petrovsky and his scientific school in the development of extracorporeal circulation, as well as his ties with S.S. Bryukhonenko (1890-1960), the founder of extracorporeal circulation in Russia. Heart-lung apparatuses were designed with the participation of collaborators of the Surgery Research Center (SRC), Russian Academy of Medical Sciences. A short account is given of the principal aspects of extracorporeal circulation, which have been studied at the SRC, such as protective blood flow distribution, centralization of circulation, the optimal perfusion rate, criteria for adequate extracorporeal circulation, control of blood coagulation and acid-base state, blood concentration, extracorporeal circulation with autooxygenation, hyperbaric perfusion, normothermal perfusion with continuous warm blood cardioplegia).

Cardiopulmonary bypass has evolved from an extremely risky procedure into a safe systematic process, and is practiced daily in thousands of centers throughout the world. Numerous individuals, from diverse specialities, have contributed to the knowledge of the processes of extracorporeal flow. The developmental sequence of advances in cardiopulmonary bypass has been divided into three nonexclusive periods based on the major changes observed during the time: (1) a conceptual and developmental period, consisting of events that occurred before 1950; (2) an applied technological period, 1950 to 1970; and (3) a refinement period, 1970 to present. Within each time frame, the major findings regarding biological and technical challenges, extracorporeal device development, and applied clinical practice will be explored. Technological advances in cardiopulmonary bypass have permitted surgeons to treat patients with both congenital and acquired heart disease, and anesthesiologists to identify appropriate mixtures of treatment regimens, whereby the risks associated with managing this challenging patient population could be minimized.

Convinced that the high risk of operation using the early heart-lung machines was due to a toxic effect of the oxygenators in use in the 1950s, Charles Drew of Westminster Hospital in London devised a circulatory support system in which the patient's own lungs functioned as the oxygenator. With this support, body temperature was reduced to the point where circulatory arrest could be tolerated for the time required to carry out the intracardiac operation. He used only this technique for the rest of his surgical career, a period of 22 years. We have attempted to record how this came to pass and to describe the qualities of this man that led him to be original and creative.