Review on the multifactorial aspects of bioincompatibility in CPB

'In cardiopulmonary bypass as applied to open heart surgery, we are no longer looking for improving one thing 100% but improving everything by 1 %.' Adapted from Mr Carlson, CEO, Scandinavian Airlines. Over the last few years, a great emphasis has been placed on the bioincompatibility of foreign, nonphysiological materials used during CPB. It is only recently that bioincompatibility has objectively been recognized to be multifactorial, with the dominant implicated sources being cardiotomy blood suction, shear stresses or flow dynamics and, to a lesser degree, the blood/artificial surface interactions, the heparin/protamine complex and the various forms of emboli or debris. In summary, in CPB, the reduction of postoperative complications, such as whole body inflammatory reactions, bleeding and organ dysfunctions, can only be impacted if the primary, dominant sources of bioincompatibility are reduced or eliminated.