Noncardiac Applications of Cardiopulmonary Bypass

Kim, Won Gon; Oh, Sam Se; Kim, Ki Bong; An, Hyuk; Kim, Chong Whan

Abstract

BACKGROUND: Cardiopulmonary bypass (CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. MATERIAL AND METHOD: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava (MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm (GA), 1 for renal cell carcinoma (RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients (MOVC 4, GA 1, RC 1). RESULT: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26degree C on average in MOVC, and 19degree C in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients (malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found.
CONCLUSION
Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.