The patient considering cardiac surgery may be provided with a choice of having his surgery performed with or without cardiopulmonary bypass. The arguments against its use are based on the sequelae related to extracorporeal flow, and not the success of the repair. The most significant consequences related to cardiopulmonary bypass can be classified pathologically into three broad categories of dysfunction: cardiogenic, hemorrhagic, and neurologic.
Post-cardiotomy cardiogenic failure has long been regarded as the number one factor that plagues a successful operation. The study of myocardial protection transcends almost five decades, with an optimum preservation strategy still serving as the Holy Grail for clinicians. Hemorrhagic defects have received intense scruitinization during the past decade primarily due to the increased awareness of the dangers inherent with autogeneic blood transfusions. Promisingly, the mitigating effects of antifibrinolytics and serine protease inhibitors have brought resolution to a number of etiological factors. If the 70s and 80s were the decades of research on myocardial protection, the 90s could surely be tagged for hemorrhagic concerns and transfusion awareness. What then is the focus of the new millennium? Without a doubt, the first decade of the 21st century will belong to the neurosciences, with an reducing the neurological injury associated with cardiac surgery and cardiopulmonary becoming the driving force.
Two individuals who have long spearheaded awareness in to the cerebral effects of extracorporeal circulation are Drs. John Murkin, from the University of Western Ontario, London, Ontario Canada, and David Stump from Wake Forest University School of Medicine, Winston-Salem, North Carolina USA. For the past decade they have organized and conducted what is deemed by many to be the most focused symposia on outcomes in cardiac surgery titled, appropriately “Outcomes”. It is held each year in Key West, Florida in the latter part of May, and attracts attendees from across the globe. Several years ago two satellite sessions were added to the general meeting: Minimally Invasive Cardiac Surgery (MICS) and Perfusion Innovations in Cardiac Surgery (PICS). The latter provides a forum dedicated to innovative research in the development of technologies that will ultimately improve the application of cardiopulmonary bypass. The Journal is proud to publish the proceedings from the 2000 meeting in this first issue of volume 34.
Also, we once again are publishing the abstracts for the scientific sessions of the 40th International Conference of the American Society of Extra-Corporeal Technology. This year the meeting will be held in New Orleans from March 21st through the 24th, at the Hilton New Orleans Riverside. The scientific history of this meeting is to present significant research aimed at improving the techniques related to perfusion and extracorporeal circulation. No other meeting on perfusion presents such a diverse subject content with an international faculty and audience. It is through such discourse, as with the PICS meeting, where the ‘meeting of minds’ provide the stimulus for continued discovery and advancement.
Sincerely,
Alfred H. Stammers, MSA, CCP
Editor