Are you or someone in your family scheduled to have major open-heart surgery? You've probably heard doctors say that you'll be connected to a "heart-lung machine." It's normal to feel a little scared and curious when you hear this name. What exactly is this machine? What does it do? Is it something to be afraid of? Let's talk about it simply and clearly.
What is Cardiopulmonary Bypass?
Simply put, this is a machine that temporarily works in place of your heart and lungs. During surgery, your body's blood is diverted through this machine instead of going to your heart and lungs. That's why it's called a "bypass."
Imagine, this machine takes over the two main tasks that your heart and lungs do during surgery:
1. Adding oxygen to the blood (this is usually done by the lungs).
2. Pumping oxygen-rich blood throughout the body (this is usually done by the heart).
When connected to this machine, doctors can temporarily stop your heart by giving you a special medicine called ``Cardioplegia''. Then, the surgeon can safely and easily operate on a heart that is not beating and not bleeding. Meanwhile, every other organ in your body receives the oxygen-rich blood it needs through this machine. Doctors also call this state "on the pump."
Are this and CABG surgery the same thing?
Yes, these two are two different things. But these two often occur together. Some people confuse these two words because they both contain the word "bypass".
- CABG (Coronary Artery Bypass Grafting): This is the actual surgery. When the coronary arteries that supply blood to the heart become blocked by fatty deposits, a new path (bypass) is created to bypass the blockage and allow blood to flow.
- Cardiopulmonary Bypass: This is a technique used to assist the surgeon during CABG surgery (or other heart surgery). It involves diverting blood flow around the heart and lungs.
That is, CABG is the surgery. Cardiopulmonary bypass is the support system used to perform that surgery safely.
How does this machine work?
To understand this, let's first recall the normal way blood flows in our body. The oxygen-poor blood in the body enters the right side of the heart through two large veins (vena cava). From there, that blood is pumped to the lungs. In the lungs, the blood is oxygenated, and that oxygen-rich blood returns to the left side of the heart. Finally, it is the left side of the heart that pumps that clean blood to the entire body.
The cardiopulmonary bypass machine temporarily removes this chakra from the body.
1. Before entering the heart, some of the oxygen-poor blood is drawn into the machine through tubes (cannulas).
2. The part inside the machine called ``Oxygenator'' adds oxygen to the blood.
3. The pump in the machine re-connects the oxygenated blood to the main artery (Aorta) that distributes blood to the body after the heart.
This is how the body receives oxygen until the surgery is over.
| Main parts of the machine | The work that it does |
|---|---|
| Cannulas | Tubes that connect to the body's blood vessels. These carry blood to the machine and back to the body. |
| Reservoir | A tank that collects oxygen-depleted blood from the body. |
| Oxygenator | This is the job of our lungs: they add oxygen to the blood and remove carbon dioxide. |
| Pump | This is the job of our heart. It pumps oxygenated blood back to the body. |
What are the steps involved during surgery?
The medical team carries out this procedure in a very planned manner. A team including a surgeon, an anesthesiologist, and a perfusionist, a specialist who has been specially trained to operate this machine, contributes to this.
- Preparing the machine: First, the air in the machine's tubes is completely removed and filled with a special liquid (priming solution). Because an air bubble (`(Air Embolism)`) entering the body is very dangerous.
- Giving you medicine to prevent blood clots: Before you are connected to the machine, you will be given a powerful blood-thinning medicine called Heparin to prevent blood clots.
- Connecting to the machine: Now the doctors will connect you to the machine. Your heart and lungs are still working at this moment.
- Heart and lung arrest: After making sure everything is working properly, the heart is stopped by administering a drug called ``Cardioplegia''. Now the heart-lung machine takes over the entire task.
- Surgery and monitoring: While the surgeon is performing the surgery, the team, including the perfusionist, continues to closely monitor the machine and your body's condition (such as temperature and blood pressure).
- Weaning: After the surgery is successfully completed, your heart is slowly restarted, your lungs are allowed to breathe, and you are removed from the machine.
What are the risks of this method?
As with any major surgery, there are risks involved in this procedure. These risks may vary depending on the length of time you are connected to the machine and your health status before the surgery.
But remember, your medical team is highly trained and experienced in managing all of these risks. Some of the complications that can occur include:
- Blood clots
- Heavy bleeding
- Stroke or brain damage
- Kidney or lung damage
- Inflammation and infection in the body
Talk openly with your doctor about these risks and the steps you can take to avoid them before your surgery.
What to do in an emergency?
When you leave the hospital after surgery, your doctor will explain to you the days you need to return and the instructions you need to follow. It is very important to follow these instructions exactly.
Most importantly: If you experience symptoms of a stroke, don't delay for a second. Go to the nearest hospital's Emergency Department (ETU) immediately.
Emergency symptoms of a stroke may include:
- Numbness or weakness on one side of the body
- Difficulty speaking, slurring of words
- Sudden confusion
- Difficulty walking, loss of balance
- Difficulty seeing
Take-Home Message
- Cardiopulmonary bypass is a standard technique that is widely and safely used in major heart surgeries. Don't be afraid of it.
- This machine allows the surgeon to easily and safely operate on a non-beating, bloodless heart.
- This is only a temporary process. After the surgery, your heart and lungs will function normally again.
- As with all surgeries, there are risks, but your medical team is highly trained to manage them.
- Discuss any questions or concerns you may have with your doctor before the surgery. This will help you feel more at ease.
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