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Cardiopulmonary Bypass and Mechanical Support: Principles and Practice

Lalonde, Genevieve MD, MSc, FRCPC

doi: 10.1213/ANE.0000000000001478
Books, Multimedia, and Meeting Reviews

Department of Anesthesia and Perioperative Medicine, Saint Boniface Hospital, Winnipeg, Manitoba, Canada,

Cardiopulmonary Bypass and Mechanical Support: Principles and Practice, fourth edition, serves as a valuable and reputable reference textbook that applies to all professionals employed within the cardiac surgical setting.

Presented in 756 pages, this textbook is organized into 6 sections and further divided into 32 manageable chapters. Input was based on the work of 75 leading contributors in the field, primarily originating from the United States, Canada, and a few from Europe. The book focuses on both the pathophysiology and the clinical applications of the heart–lung machine. Specifically, the history of cardiopulmonary bypass (CPB), CPB equipment, relevant pathophysiologic and hematologic aspects, and the clinical applications for CPB, including pediatric CPB, are discussed in detail. In addition, the authors present a renewed emphasis on the importance of patient safety, effective communication skills, and the value of teamwork throughout the book.

Inspiration for the creation of a fourth edition stems from recent advances in cardiopulmonary sciences, technology, and clinical practice. Chapters on mechanical circulatory support devices have been reorganized, reflecting short-term and long-term applications. Contemporary univentricular and biventricular cardiac, as well as pulmonary assist device technologies, have been included. The authors have acted on the recommendation offered by Mauermann1 in a third edition book review to discuss in depth the use of extracorporeal membranous oxygenation for adult patients who require circulatory support. Gravlee et al also include a whole discussion on venoarterial and venovenous extracorporeal membranous oxygenation in pediatrics. Also, this new edition now encompasses an eBook format in addition to the traditional paper version.

The format of the textbook is convenient and easy to follow for inspired readers. Being color coded, the transitions between chapters can readily be understood. The accompanying figures and tables are relevant and precise; they assist the reader in gaining a better appreciation and understanding of the subject. Key points presented at the end of each chapter offer a summary of the most relevant data and perspectives. Furthermore, reference lists for each chapter are extensive and up to date, with many from the year 2015.

The eBook version is available for iOS, Android, PC, and Mac, making content accessible anytime, regardless of data connection. The eBook has the same content as the paper printed version with additional capabilities, such as writing and sharing personal notes with colleagues, highlighting text, and page bookmarking. The simple search function facilitates finding information. Portable, the eBook is very convenient for the modern health care professional to find information in a timely manner while also serving as a resource to teach and engage students.

Other major anesthesia textbooks, such as Clinical Anesthesia2 or Miller’s Anesthesia,3 provide a comprehensive but broad overview of CPB directed primarily toward the needs of a general anesthesiologist. Cardiopulmonary Bypass and Mechanical Support explores similar themes, such as the equipment and clinical application of CPB, however, in much greater depth. In addition, Gravlee et al’s textbook includes superior detail and depth on neurologic, respiratory, metabolic, hematologic, and inflammatory responses to CPB, as well as pediatric CPB. In other words, this textbook presents more specific content compared with other available general anesthesia textbooks; therefore, it is more relevant to cardiac anesthesiologists and cardiac surgery staff compared with a more general medical audience.

Kaplan’s Cardiac Anesthesia4 addresses similar topics to those of Gravlee et al, with the addition of perioperative echocardiography, monitoring, and heart diseases. On the other hand, Cardiopulmonary Bypass and Mechanical Support focuses first and foremost on the central theme of physiology and clinical applications of the heart–lung machine. Therefore, the scope of Gravlee et al’s content is more precise and directed toward CPB. Furthermore, it includes a dedicated section on pediatric CPB, which Kaplan et al did not cover in any great detail. Published in 2016, fundamental and clinical data presented in Gravlee et al’s fourth edition are more recent than the Kaplan et al’s sixth edition.

Although the book serves as a useful reference, relevant to the pragmatic cardiac anesthesiologist, cardiac surgeon, perfusionist, and intensivist, it does have some limitations. There is a potential risk for a North American cultural and practice bias because of the prevalence of American authors. For the textbook to truly reflect the international environment, it could potentially include a broader scope of authors to replicate multiple global perspectives and practices. In addition, providing active Web links to supplemental videos and data could enhance the eBook and ensure the latest information is available to the reader.

Some chapters deserve more attention than others because they are more relevant, attractive, and are applied to the modern cardiac environment. The 2 chapters on mechanical circulatory support devices are current and best describe the different technologies available on the market. Although the authors introduce the main clinical issues, limited detail is presented concerning the precise anesthetic and perfusionist management within an operating room and the long-term care within the intensive care unit. The chapter on surgical myocardial protection describes meticulously the established, emerging, and experimental strategies for myocardial protection. The mechanism for each strategy is well explained and supported by relevant studies. The editors dedicate a whole section on the human physiologic responses to CPB. The chapters on neurologic and hematologic consequences of CPB are extensive and complete. Contemporary trends and clinical relevance of monitoring are supported by recent studies and actual practice. A significant topic currently not addressed in the book concerns available literature related to the management of the bleeding cardiac surgical patients, especially for patients taking the new generation of novel oral anticoagulants. This topic is currently not covered in the book. Cardiac teams must be cognizant of the available medical therapies required to effectively react and to manage this category of patients.

In summary, Cardiopulmonary Bypass and Mechanical Support serves as a complete and specific source of information for professionals who are highly involved in cardiac surgical care. As a viable and reliable reference, this textbook may contribute toward the safe and effective delivery of modern CPB practices and procedures.

Genevieve Lalonde, MD, MSc, FRCPCDepartment of Anesthesia and Perioperative MedicineSaint Boniface HospitalWinnipeg,

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1. Mauermann WJ. Cardiopulmonary bypass: principles and practice. Anesthesiology. 2008;108:766767.
2. Barash PG, Cullen BF, Stoelting RK, Cahalan M, Stock MC, Ortega R. Clinical Anesthesia. 20137th ed. Philadelphia, Pa: Wolters Kluwer.
3. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller’s Anesthesia. 20158th ed. Philadelphia, Pa: Elsevier
4. Kaplan JA, Reich DL, Savino JS. Kaplan’s Cardiac Anesthesia: The Echo Era. 20116th ed. Philadelphia, PA: Elsevier
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