Historical aspects of cardiopulmonary bypass: from antiquity to acceptance.

Cardiopulmonary bypass has evolved from an extremely risky procedure into a safe systematic process, and is practiced daily in thousands of centers throughout the world. Numerous individuals, from diverse specialities, have contributed to the knowledge of the processes of extracorporeal flow. The developmental sequence of advances in cardiopulmonary bypass has been divided into three nonexclusive periods based on the major changes observed during the time: (1) a conceptual and developmental period, consisting of events that occurred before 1950; (2) an applied technological period, 1950 to 1970; and (3) a refinement period, 1970 to present. Within each time frame, the major findings regarding biological and technical challenges, extracorporeal device development, and applied clinical practice will be explored. Technological advances in cardiopulmonary bypass have permitted surgeons to treat patients with both congenital and acquired heart disease, and anesthesiologists to identify appropriate mixtures of treatment regimens, whereby the risks associated with managing this challenging patient population could be minimized.