John Gibbon

Question 1

Who was John Gibbon?

Answer 1

• an American surgeon (MD from Jefferson in 1927) best known for inventing the heart-lung machine and performing subsequent open heart surgeries which revolutionized heart surgery in the twentieth century.
  In 1953 at Jefferson Hospital in Philadelphia, he used total cardiopulmonary bypass for 26 minutes, to close a large secundum atrial septal defect in an 18-year-old woman.

Question 2

What is the heart-lung machine (aka cardiopulmonary bypass)?

Answer 2

• a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient’s body. Gibbon’s machine was a device that used a screen oxygenator, which allowed blood on both sides of the screen mesh to interface with oxygen, and three roller pumps modified from Dr. DeBakey’s original transfusion pump design to pump the blood back into the body.

Question 3

How was blood diverted from the body to the heart-lung machine in 1953?

Answer 3

• after complete heparinization, an arterial inflow cannula was placed in the left subclavian artery, and the inferior and superior vena cava were cannulated with plastic tubes. All this was done through a large, bilateral submammary incision (clamshell incision), which lifted up the entire upper thoracic area to expose the heart (an incision that is rarely, if ever, used in modern cardiac surgery). After opening the atrium, a large secundum atrial septal defect was encountered, which was closed with a running cotton suture.

Question 4

How does cardiopulmonary bypass work today?

Answer 4

• The surgeon places a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body. The cannula is connected to tubing filled with isotonic crystalloid solution. Venous blood that is removed from the body by the cannula is filtered, oxygenated, and then returned to the body. The cannula used to return oxygenated blood is usually inserted in the ASCENDING AORTA, but it may be inserted in the femoral artery. The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse effects of heparin. During the procedure, hypothermia may be maintained; body temperature is usually kept at 28 °C to 32 °C (82.4–89.6 °F). The blood is cooled during CPB and returned to the body. The cooled blood slows the body’s basal metabolic rate, decreasing its demand for oxygen.