The advent of cardiopulmonary bypass revolutionised cardiac surgery because it allowed for complex procedures to be undertaken in the knowledge that the bypass circuit could support vital organs for several hours. Over the decades, however, the risk profile of the patients for whom cardiac surgery is indicated has changed. The known deleterious effects of cardiopulmonary bypass have a proportionately greater impact on those older patients with a greater range and severity of co-morbid conditions who come to cardiac surgery today. “Off-pump” surgery for the epicardial coronary vessels was driven by a desire to avoid the unwanted effects of cardiopulmonary bypass but the technique is not applied universally and indeed can not be applied to many procedures (e.g. valve replacement) where cardiopulmonary bypass is still mandated.
Miniaturisation of the cardiopulmonary bypass circuit is a theoretically attractive approach to minimising some of the adverse effects of cardiopulmonary bypass. Concerns remain, however, about the safety of mini-bypass and the risk of air embolism in particular. This meta-analysis provides some useful data about the safety and efficacy of miniaturised cardiopulmonary bypass.
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