Begona Fernandez |
Madrid (EFE).- Operating on an open heart and with a zero beat thanks to an extracorporeal circulation machine that allows the lungs and heart to stop to work inside it is a technique implanted in reference hospitals around the world and that is turning 70 years with “fantastic results and survival rates of over 95%.”
“The probability that extracorporeal surgery with this machine, known as ‘heart-lung’, goes well is very high and that it goes wrong is very low with mortalities in some procedures of 1% or less and always below 5%,” he says In an interview with EFE, the cardiovascular surgeon Gregorio Rábago, son of Gregorio Rábago (1930-1992), who in 1958 performed the first extracorporeal cardiovascular surgery in Spain with this machine. Five years earlier, it had been done in the United States by its inventor, Dr. John H. Gibbon.
Rábago, who is deputy director of the department of cardiology and cardiac surgery at the Clínica Universitaria de Navarra and is specialized in heart transplantation, explains that this machine creates a new blood circulation, a substitute heart-lung for the patient, which allows endless performances inside the heart, something that before 1953 was impossible, only worked on the surface.
This surgery expert calculates that at least 25,000 people with all types of heart disease pass through this machine every year in Spain and in the world the processes number in the millions.
Operating on an 80-year-old patient is the order of the day
The profile of patients who undergo this technique is very varied, although they are getting older. “When I started, operating on someone 80 years old was unthinkable, today it is the order of the day,” says this cardiovascular surgeon.
Patients with all kinds of cardiac pathologies and many surgeries that require keeping the heart stopped and stopping blood circulation pass through the machine, without causing any organic damage.
With this machine, which has evolved over time, a pump drives the blood and an oxygenator (which replaces the lungs) replenishes the oxygen that the tissues and organs have been consuming. To operate on the heart surgically, in most cases it is not enough to maintain its function through extracorporeal circulation, but it is necessary to stop its beating, and even empty its cavities of blood to work inside.
According to Rábago, the time required for an operation with this machine is very heterogeneous and can be between two or three hours up to ten or twelve, “it depends on the complexity”. “We are seeing more and more complicated procedures because we feel more confident and able to guarantee patient safety,” he says.
“In these operations the heart is not necessarily stopped all the time, it can be stopped for 5 or 6 hours and then function without a problem,” he explains.
65 years ago, when his father, at just 28, led cardiovascular surgery with one of these machines, the situation was different.
Up to 18 health professionals intervened in that first extracorporeal cardiovascular surgery on a 20-year-old patient with a pathology in the pulmonary artery, a narrowing of the valve that did not allow blood to pass to the lung and be oxygenated, greatly conditioning his life.
Although the machine was crude, the operation went well, although the patient died eight days later of adrenal hemorrhage.
The event sparked a debate in the medical-surgical classroom at the headquarters of the Madrid College of Physicians, which concluded that the process was carried out correctly according to the techniques of that time.
The evolution of the machine has brought perfusionist nurses
This surgery still requires a multidisciplinary team today, although not as numerous as those of 65 years ago thanks to advances in technology.
What it does require is the presence of a perfusionist technician who is generally a nurse specialized in performing extracorporeal circulation and any surgery that requires stopping the functions of the heart and lung.
Rábago assures that these machines are found in all level 3 hospitals, that is, those that are at the “top” in terms of surgical equipment and training for transplants.
This is a technique financed by the National Health System that is also found in private clinics and is available in all autonomous communities.
Facing the future, Rábago admits that there is always room for improvement because in science “everything is never completed one hundred percent” but in medicine, he says, technology has to go hand in hand with patient safety, so evolution is something more. slow.
This cardiovascular surgeon considers that one of the areas in which the machine can be improved is in the materials so that they are more biocompatible and in the levels of security with more power to detect any anomaly.
And to publicize this machine, the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) wanted this year to pay tribute to the pioneers in its use, both Dr. Gibbon who used his invention at Jefferson University Medical 70 years ago Philadelphia Center as Gregorio Rábago, at the Jiménez Díaz Foundation in Madrid, 65 years ago now.