Extracorporeal circulation: what it is and how it is performed
Extracorporeal circulation allows the oxygenation and pumping of circulating blood during the middle phase of a cardiac surgery (performed with a stopped heart), when the heart is stopped in order to, for example, repair or replace a valve or ascending aorta or perform bypasses
In some operations it may be necessary to stop the extracorporeal circulation for short periods of time
During this non-circulatory phase, it is necessary to protect the brain from possible ischaemic damage.
To do this, selective cerebral perfusion is performed under hypothermia, directly perfusing the brain through the carotid arteries with blood at a lower than normal temperature.
This technique, indispensable in some cases, greatly reduces the risk of neurological complications, but does not eliminate it entirely.
In addition, extracorporeal circulation can be complicated by malperfusion of various organs
Among the organs that may be involved, those most at risk are the encephalon and the kidneys, with the risk of the onset of transient postoperative renal failure.
In cases where renal damage with chronic insufficiency already exists before surgery, this may worsen after surgery, necessitating the use of temporary or in very rare cases permanent filtration or dialysis treatments.
In some operations (such as in the case of coronary artery bypass surgery), it is possible to perform the operation with a beating heart without the use of extracorporeal circulation in selected patients.
This type of surgery does not pose the risk associated with extracorporeal circulation, but it is not applicable in all cases.
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How is extracorporeal circulation performed?
Blood is taken from the right atrium or from the hollow veins of the heart and diverted to the heart-lung machine, where it is filtered, oxygenated and returned to the patient at the level of the most distal part of the ascending aorta.
Through the use of some special solutions (cardioplegia), the heart is stopped and its cells and metabolism are protected when it is not supplied with blood in the middle phase.
At the end of the operation, the heart is perfused again and starts beating again.
The extracorporeal circulation is then gradually stopped, allowing the heart and lungs to resume their normal work.
Is extracorporeal circulation dangerous or painful?
It is now a reliable and safe perfusion method with a generally extremely low risk of complications.
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