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Extracorporeal surgery refers to open-heart operations where it’s necessary to stop its function to operate on it.

Professionals from the Cardiovascular Surgery service at the Regional University Hospital of Málaga have performed the 10,000th extracorporeal surgery. This type of interventions requires the participation of a dozen professionals in the operating room given the complexity of these open-heart operations.

The first extracorporeal intervention was carried out on August 6, 1980, on a 19-year-old patient who was urgently admitted to the General Hospital -formerly Carlos Haya. Since then, the technology surrounding these interventions has evolved alongside the technique, allowing 10,000 people to be operated on.

The head of the service, Enrique Ruiz, explains that extracorporeal circulation is the technology that makes it possible to operate on heart patients:
“It involves a machine that functions as a heart and lung during surgery. It acts as a heart because the blood leaves the patient, goes to the machine, and this pumps it back into the body. And it serves as a lung because it oxygenates this blood, since it also has an artificial lung. What is achieved is that the patient’s heart is stopped, so as to be able to fix in surgery what is malfunctioning, whether they are the coronary arteries, the heart valves, or some congenital holes. At the end of the surgery, when the patient’s heart is fixed and has been restarted, the process is reversed, and this organ begins to function on its own, without the need for the machine.”
These surgeries account for 90% of those performed by this service in the operating rooms of the General Hospital. The pathologies that require this type of complex interventions are the narrowings in the coronary arteries that cause a lack of irrigation in the heart muscle itself. “The muscle hurts and manifests as angina or infarction. What we surgeons usually do are bridges to carry flow beyond the obstruction, using the patient’s own arteries or veins,” Ruiz explains.

On the other hand, diseases of the heart valves, such as those on the left side -mitral and aortic- or on the right side -tricuspid and pulmonary-, are also operated with extracorporeal circulation. “When a valve is damaged, two things can happen: either the opening is not wide enough, or the closure is incomplete and there is a slight opening through which blood goes backwards. Sometimes both things happen at the same time. Many times repairs are made to these valves, although it is common to have to replace them with a prosthesis or artificial valve, which can be biological or mechanical,” he points out.

Lastly, and more infrequently, cardiovascular surgeons also intervene on aortic aneurysms to prevent them from rupturing.

From the first extracorporeal surgery to date, there have been multiple teams and the working method has evolved. “We have moved towards less invasive techniques that require smaller incisions, which results in the well-being and recovery of the patient.”

The team involved in these operations is multidisciplinary and acts in a coordinated manner. From the anesthetist, who controls the patient, the surgeons who, with the nursing professionals work on the patient and the instruments, to the perfusionist, nursing with specific training for the management of extracorporeal circulation who controls the details while the extracorporeal machine operates and coordinates for the entry and exit from the procedure.

In this regard, Juan Carlos Santos, one of the perfusionists who perform these interventions and who has participated in the 10,000th one, explains that with extracorporeal circulation they perform the function of the heart and lung, and a solution is administered to stop the heart, so that the surgeon can perform the surgical intervention. “In addition, we use different procedures to avoid blood transfusions and always supported with the best technologies that guarantee us the maximum safety for our patients throughout the extracorporeal circulation,” he adds.

For Santos, reaching this number is “to remember all the professionals who during all these years have been developing their work in the operating room. At this moment I remember all those colleagues who have participated in them with their dedication and enthusiasm, with their good and bad moments. But above all, I think of those thousands of patients who have benefited from these interventions that have made their life better,” he adds.

Likewise, Enrique Ruiz points out that “several generations of surgeons and other professionals have made this journey possible. Few hospitals or centers can boast of a figure like this. We can be proud of our trajectory as a hospital with cardiovascular surgery and build a great future among all the professionals who work in it to continue improving the heart health of the people of Málaga,” he concludes.
Original news in the Press Room of the University Hospital of Málaga, more information [here](http://www.hospitalregionaldemalaga.es/NoticiasyEventos/SaladePrensa/tabid/123/ctl/ArticleView