Introduction

The development of cardiopulmonary bypass (CPB) has enabled operative treatment for countless numbers of patients with a multitude of acquired and congenital cardiac, vascular, and thoracic anomalies. The CPB machine is a unique device designed to divert a patient’s circulation around regions that requires surgical intervention, so that surgeons can operate in an anatomic area that would otherwise be filled with blood. The typical CPB circuit consists of a series of pumps that provide cardiopulmonary support through disposable components consisting primarily of tubing, a blood collection reservoir, and an oxygenator. The venous blood is pumped through the oxygenator and is returned to the arterial system of the patient.

The first successful open heart surgical procedure using extracorporeal CPB was performed in 1953 by John Gibbon, using a machine of his own design.[1] Since then, there have been numerous improvements to multiple domains of CPB, including:

• the CPB device itself,
• the disposable components used for CPB,
• the techniques and strategies of CPB, and
• the monitoring and safety systems associated with CPB.

These innovations have been associated with steadily improving patient outcomes. This chapter will provide a general overview of CPB and strategies used during pediatric and congenital cardiac surgery.