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Elective Cardiac Arrest in Open-Heart Surgery

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Abstract

IN 1954, Warden, Cohen, Read, and Lillehei1 reported their initial experience in open-heart surgery with cross-circulation technics. Their imaginative approach and experience have given impetus to the solving of the most formidable problem in cardiac surgery. In succession, the principle of cross circulation using compatible donors, the utilization of the dog-lung preparation, and finally the perfection of the bubble-type oxygenator have introduced the era of open-heart surgery. Their work has given promise that safer and more economical methods will evolve for performing direct-vision surgery within the living heart.

Open-heart surgery requires occlusion of the venous systemic return to the heart with detour of the unsaturated blood to an oxygenator that will return blood through a major artery, usually the subclavian (Fig. 1). This bypassing procedure permits satisfactory perfusion of vital organs with a reduced flow of blood employing the “azygos flow principle.”2 This technic permits open-heart surgery via auricle or ventricle, but it does not offer a dry operating field. Although no blood returns via the venae cavae, there is a significant flow through the coronary circulation, emptying by way of the coronary sinus and the thebesian veins into the heart. In addition there may be partial aortic valvular incompetence with retrograde flow through a septal defect, and there may be a significant collateral circulation emptying into the left side of the heart, the latter in those cases where there is obstruction of the right ventricular outflow (e.g. tetralogy of Fallot). Since these channels may permit a considerable loss of. . .


 

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