Noncardiac Indications of Cardiopulmonary Bypass

Abstract

The cardiopulmonary bypass has been used effectively in the management of open heart surgeries. This stimulated an appraisal for application of cardiopulmonary bypass in non-cardiovascular uses such as renal surgery, liver transplantation, pulmonary surgery, tracheal surgery, neurosurgery, vascular surgery, respiratory failure, malignant hyperthermia, and shock.

During CPB, the heart and the lungs are excluded from the circulation and replaced by an artificial pump and oxygenator, which thus permits surgery on the heart, great vessels, and other structures.

During CPB, blood is circulated by a mechanical pump independent of physiologic controls. Changes in hemodynamics, changes in blood constituents, changes in fluid balance and multiple organ dysfunction occur during CPB.

The use of CPB in renal surgery is mainly concerned with resection of kidney tumors, mainly renal cell carcinoma, which extend to the inferior vena cava superiorly past the diaphragm and may reach the right atrium. Since complete removal of the tumor is critical to survival, a quite motionless bloodless right atrium allows the best chance for complete resection of the tumor.