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Ann Thorac Surg 2005;79:2038-2039
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Invited commentary

Gabriel S. Aldea, MD

Division of Cardiothoracic Surgery, University of Washington School of Medicine, Box 356310, 1959 NE Pacific St, AA115, Seattle, WA 98195-6310

(E-mail: aldea@u.washington.edu).

The first 20% of the full text of this article appears below.

Despite many theoretical opportunities and possibilities, the goal of complete attenuation of inflammation and ischemia reperfusion injury after cardiopulmonary bypass (CPB) by a single strategy remains elusive. This may reflect the primal teleological redundancy of the inflammatory and coagulation systems and requires a fundamental change in our often overly simplistic uni-dimensional approaches to these problems. At its extreme, this appreciation leads to a nihilistic intellectual pessimism that concludes that perturbations after artificial perfusions are unavoidable and severe and that CPB should be abandoned whenever possible. This position ignores many of the theoretical and pragmatic advances that were made in the field of artificial perfusion in the past 4 decades. It also ignores the overwhelming clinical observation that most patients tolerate these perturbations without major, catastrophic, adverse or long-term consequences. . . . [Full Text of this Article]




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