The Effects of Prostacyclin on Reducing Cerebral Damage Following Open-Heart Surgery

Abstract

Cardiopulmonary bypass has been a routine procedure for a quarter of a century. Until the discovery of prostacyclin with its powerful inhibiting effect on the blood platelet, by Vane and his group in 1977 [1], there was no opportunity for revolutionary changes which promise to make the technique safer. Surgical results, however, have gradually improved because of small incremental refinements of technique. Better prosthetic implants and a better understanding of homograft materials have also helped. From the late 1950s to the mid-1970s, open-heart surgery was still too difficult and expensive to be undertaken outside specialized centres. It was routine only in adults with well-advanced disease and on children and infants with congenital deformities. The indications for surgery were strict. Only patients with disease so advanced that it was potentially lethal were referred for operation, and then only when cardiac failure was imminent. The possibilities of bacterial endocarditis or advancing pulmonary hypertension were also indications for surgery.