Does cardiopulmonary bypass still represent a good investment? The biomaterials perspective

Cardiopulmonary (CPB) bypass is 50 years old this year, and has undergone considerable change in that time, particularly with regard to developing technology. However, in recent years the routine application of CPB, as the treatment of choice for patients undergoing reparative heart surgery, has been challenged by new, evolving techniques, particularly Off-Pump Coronary Artery Bypass (OPCAB) and stenting. This paper considers whether CPB still represents a sound investment prospect, with particular emphasis on the biomaterial developments currently taking place. Whilst we accept that routine application of CPB is shrinking under pressure from less invasive techniques, we suggest that this may represent an opportunity to deliever a more highly evolved perfusion to the core of very sick and complex patients who may not be suitable candidates for OPCAB or stenting. These patients will benefit from the application of new technologies currently under development, such as smaller perfusion circuits, improved biomaterial surfaces, smart membranes, and biosensor technology, all aimed at making clinical perfusion a safer and more predictable procedure for the patient. All things considered, we feel that CPB, although shrinking in absolute size, still represents a good investment.