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Sergei S. Brukhonenko: the development of the first heart-lung machine for total body perfusion


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Sergei S. Brukhonenko designed and constructed one of the earliest heart-lung machines. He was the first to experimentally perform a total body perfusion with the heart of the animal isolated from the circulation. His work paved the way to the first experimental operations on heart valves. Although Brukhoneko's pioneering contributions have not received the recognition they deserve, his work represents an important landmark in cardiac surgery.
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Sergei S. Brukhonenko: The Development of the
First Heart-Lung Machine for Total Body Perfusion
Igor E. Konstantinov, MD, and Vladimir V. Alexi-Meskishvili, MD, PhD
Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota and German Heart Institute, Berlin, Germany
Sergei S. Brukhonenko designed and constructed one of
the earliest heart-lung machines. He was the first to
experimentally perform a total body perfusion with the
heart of the animal isolated from the circulation. His
work paved the way to the first experimental operations
on heart valves. Although Brukhoneko’s pioneering con-
tributions have not received the recognition they deserve,
his work represents an important landmark in cardiac
(Ann Thorac Surg 2000;69:962– 6)
© 2000 by The Society of Thoracic Surgeons
“The solution of the problem of the artificial circulation of the
whole animal opens the door to the problem of operations on
the heart, for example on the valve.”
Sergei S. Brukhonenko, 1928
The development of the heart-lung machine by John
Heysham Gibbon (1903–1973) is well known and
recognized [1, 2]. In 1931, after witnessing the death of a
patient from pulmonary embolectomy, Dr Gibbon had an
idea for the heart-lung machine. By 1942, he was able to
keep cats alive on his experimental devices, with contin-
ued survival after bypass. On May 6, 1953, Gibbon
performed the world’s first successful open-heart opera-
tion using extracorporeal circulation on an 18-year-old
woman with a large atrial septal defect. The name Gib-
bon is well known to cardiac surgeons.
The name of Brukhonenko, however, and his pioneer-
ing work on the heart-lung machine is rarely mentioned
in the English language surgical literature. In 1997, Fou,
in her article entitled “The First 20 Years of the Heart-
Lung Machine” and devoted to John H. Gibbon, wrote:
“Other names emerging in the field of thoracic surgery
included those of..., and Brukhonenko and his col-
leagues in Russia” [2]. In 1960, Probert and Melrose, in
their article “An Early Russian Heart-Lung Machine,”
published in the British Medical Journal wrote: “In the
development of the heart-lung machine for extracorpo-
real circulation the contributions of the distinguished
Russian scientist, Professor S.S. Brukhonenko, have not
hitherto received the recognition they deserve” [3]. De-
spite thorough literature review, we did not find any
biographical material on Professor Brukhonenko pub-
lished in English, French, or German. Who was this
obscure Dr. Brukhonenko? What is his contribution to
the development of the heart-lung machine?
Landmarks in Extracorporeal Circulation
It is important to briefly outline the history of artificial
circulation to appreciate the work of Brukhonenko and
his contributions to the development of modern extra-
corporeal technology.
The history of the extracorporeal circulation begins in
1813, when LeGallois suggested that vitality of part of the
body might be preserved by means of the artificial
circulation [4]. In 1858, Brown-Sequard used the limbs of
guillotined prisoners and demonstrated that reflex ner-
vous activity could be preserved if perfusion with oxy-
genated blood was initiated promptly [5]. He achieved
blood oxygenation by the whipping of “black” blood, and
forced the oxygenated blood through the arteries by
means of a syringe. In 1868, Ludwig and Schmidt de-
scribed an apparatus for arterial blood infusion from a
reservoir into an isolated surviving organ [6]. In 1882, von
Schroder described a bubble oxygenator with air bub-
bling through the venous blood from the bottom of the
bottle, thereby producing foam [7]. The first heart-lung
machine, in which the oxygenation of the blood could be
accomplished without the interruption of the blood flow,
was devised by von Frey and Gruber in 1885. The blood
was spread as a thin film exposed to the oxygen over the
inner wall of a rotating cylinder [8]. In 1895, Jacobj used a
perfusion apparatus employing dog lungs or the pulmo-
nary lobes of pigs or calves as oxygenators [9]. In 1855,
the first roller pump was patented by Porter and Bradley
It can, therefore, be stated that a century ago, three
systems were already in use, namely the bubble oxygen-
ator, the film oxygenator, and the lung as an oxygenator.
The roller pump was described, and experimental perfu-
sion of isolated organs was successfully performed. How-
ever, it was not until Brukhonenko conducted his exper-
iments in 1920s that the feasibility of total body perfusion
after heart removal was established [11].
Address reprint requests to Dr Konstantinov, Thoracic and Cardiovascu-
lar Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55902; e-mail:
© 2000 by The Society of Thoracic Surgeons 0003-4975/00/$20.00
Published by Elsevier Science Inc PII S0003-4975(00)01091-2
Biography and Work
Sergei Sergeevich Brukhonenko (1890–1960) (Fig 1) was
born on April 30, 1890 in the small Russian town of
Kozlov into the family of a civil engineer. While still a
teenager, Brukhonenko made his first invention. It was a
self-designed and self-constructed bicycle (Fig 2). Bruk-
honenko received his premedical education in Saratov
and then moved to Moscow to study medicine. After
graduation from the Medical Faculty of the University of
Moscow in 1914, Brukhonenko was assigned to the active
army as a junior doctor to an infantry regimen. During
World War I, having witnessed many cases of traumatic
shock and combat injuries of the lungs, heart, and major
vessels, he thought of ways for temporal extracorporeal
circulation to support life while injuries are repaired [12].
In Autumn 1917, Brukhonenko returned to Moscow and
worked for the Sanitary Council of Sokolniky’s region of
From 1919 to 1926, he was assistant professor at the
Department of Clinical Pathology and Therapy of the
Military Hospital in Lefortovo, in the outskirts of Mos-
cow. While working there, he attended many patients
with typhus and malaria.
Brukhonenko first approached the problem of the
extracorporeal circulation in 1923, when he was studying
the trypanocidal drug Suramin (Bayer 205, Germanin,
Nagonal) at the State Institute for Chemistry and Phar-
macology in Moscow [13, 14]. Finding that this drug was
capable of producing an “artificial haemophilia,” he
began to use it as an anticoagulant in blood transfusions
[15]. According to Probert and Melrose, Brukhonenko
was using roller pumps in his work on transfusion [3].
In 1926, in collaboration with Dr Tchechulin, he de-
signed an apparatus for the “artificial circulation with
blood of warm-blooded animal” [16]. The device was
named “autojector” (Fig 3). The apparatus consisted of
two mechanically operated diaphragm pumps with a
system of valves. The excised lungs of a donor animal
Fig 1. Sergei Sergeevich Brukhonenko (1890–1960). Courtesy of Lut-
fia Arifulova, Russian Academy of Medical Sciences.
Fig 2. Sergei Brukhonenko sitting on the self-constructed bicycle
with his family. Courtesy of Lutfia Arifulova, Russian Academy of
Medical Sciences.
Fig 3. Bruchonenko’s autojector with donor lungs for blood oxygen-
ation. Reprinted from reference 17.
acted as an oxygenator. One pump delivered venous
blood into the oxygenator; the other pumped the oxygen-
ated blood from the donor lungs into the systemic circu-
lation of the perfused animal. The blood of the donor and
the experimental animals was treated with Suramin. In
their experiment conducted on November 1, 1926, the
heavy ligature was placed around the heart at the atrio-
ventricular grove so that the contraction ceased. The dog
was kept alive for 2 hours by means of extracorporeal
circulation only. Sudden massive bleeding from the in-
ternal mammary artery interrupted the experiment [16
18]. This was, apparently, the world’s first experiment of
its type. After description of eight experiments, Bruk-
honenko wrote: “by conducting these experiments we
wanted to clarify the principle possibility of surgery on
the temporary arrested heart,” and concluded that “in
principle, the artificial circulation may be used for certain
operations on the arrested heart, however, further im-
provement of the technique is necessary for its practical
implementation” [16–18].
In the succeeding years, Brukhoneko pursued a series
of research both with isolated organs and with total
perfusions [18]. On June 1, 1928, he demonstrated some
of the experiments to the international audience at the
3rd Congress of Physiologists of the USSR. Early in the
next year, a correspondent of the La Presse Medicale paid
a special visit to Moscow; he described this research and
published photographs of the apparatus in action [3, 19].
The isolated head reacted briskly to the environment,
opened its mouth, and even swallowed a piece of cheese
placed in it. The experiment was demonstrated to A. V.
Lunacharsky, Russian Minister of Education, and to the
international scientists, among them Professor Haldane
from the United Kingdom [17]. The news of the head
surviving after being cut off from the rest of the body
caused a wave of anxiety among laymen in Europe. G.
Bernard Shaw wrote a letter on March 12, 1929 and
speculated about the input of “Brukhonenko’s most in-
teresting experiments” on preservation of human knowl-
edge [20].
There was also one much more practical application of
Brukhonenko’s device. In his article submitted on Octo-
ber 11, 1928 to the French magazine Journal de Physiologie
et de Pathologie Generale, Brukhonenko wrote about the
artificial circulation: “Would not this method, duly per-
fected, be useful in clinical medicine: notably in those
cases where it would be essential to replace, if only for a
time, the work of the failing human heart? Without going
more deeply into this question we can state as a result of
the present work, that in principle artificial circulation is
applicable to man not only clinically, but also for certain
operations on the temporarily arrested heart. For its
achievement, however, a suitable technique would have
to be worked out” [3, 16, 17].
In 1931, Brukhonenko performed experiments with
deep hypothermia. Using his autojector device, the dogs
were cooled down to 3°C with resulting hypothermic
cardiac arrest. After rewarming, the restoration of normal
cardiac function and the dogs’ survival were achieved
[20]. Brukhonenko applied for a patent on his “Device for
Artificial Circulation” in Russia on November 29, 1928.
On December 15, 1934, the patent was issued (USSR
patent No. 35976). In 1929, the device was patented both
in Germany (No. 139825) and in England (No. 30708/28);
and in 1930, in France (No. 662878).
From 1929 to 1937, the autojector was successfully used
in open heart operations on dogs performed by Terebin-
ski [21–24]. In 1940, Nikolai Terebinski (1880–1959) pub-
lished a monograph and reported excellent results of
more than 260 open heart operations on dogs. Though
the device was suitable for experimental open heart
operations, it required donor lungs for blood oxygen-
ation, and as such could not be applied clinically.
In 1936, Brukhoneko designed a bubble oxygenator
and called it the “artificial lungs,” thus completing his
heart-lung machine. He applied for a patent on March 31,
1937. It was issued on May 31, 1942 (USSR patent No.
61321). The device consisted of a double-wall glass vessel,
with the inner vessel used for the foam-type blood
oxygenation, while the outer vessel was filled with an
acid and used as an electric heater (Fig 4). The vessel was
placed on a scale with a balance occlusion system that
occluded the blood outlet when the blood level in the
vessel was too low. The oxygen was bubbling through the
venous blood from the bottom of the inner vessel, pro-
ducing foam. The foam was suppressed by alcohol and
the oxygenated blood was returned into the body. In
1937, by means of his heart-lung machine, Brukhonenko
achieved complete recovery in a dog after 7 minutes of
Fig 4. Brukhonenko’s bubble oxygenator: 1, balance; 2, holding
stent; 3, glass vessel; 4, electrodes placed in acid for heating with
electric current; 5 and 6, thermoregulator system; 7, inner glass ves-
sel; 8 and 9, rubber corks; 10, rubber tube; 11 and 12, occlusion sys-
tem; 13, oxygenated blood outlet to the body; 25, venous blood inlet;
34, glass vessel filled with water only; 35, glass vessel filled with
water and alcohol; 36, thermostat; 37, oxygen inlet. Reprinted from
Brukhonenko SS. Device for oxygenation of the blood. USSR Patent
No. 61321 issued on May 31, 1942.
normothermic circulatory arrest. In 1939, 12 out of 13
experimental animals were resuscitated using the heart-
lung machine after 10 minutes of circulatory arrest. All
dogs recovered completely without any residual neuro-
logical damage [24].
Terebinski and Brukhonenko were eager to apply the
heart-lung machine clinically. In 1941, the machine was
safe and reliable enough for clinical application. How-
ever, World War II interrupted their work.
The war caused enormous cultural, scientific, and
economic damage. As many as 27 million of Brukhonen-
ko’s fellow citizens may have died. Material losses are
even more difficult to establish, but 30% of the national
wealth was destroyed. It took decades for the economy to
recover. After the end of World War II and up to 1951,
Brukhonenko worked in the Sklifosofsky Emergency In-
stitute in Moscow. Although Terebinski and Bruk-
honenko resumed their experiments in the early 1950,
they simply had no time to implement their ideas into
clinical practice. Terebinski died in 1959 at the age of 79.
Vita brevis, ars longa! Brukhonenko then attempted to use
the heart-lung machine for emergent resuscitation after
sudden death. It was a daring idea, original and challeng-
ing, and it was also a failure. There were no survivors.
From 1951 to 1958, Brukhonenko headed the physiol-
ogy laboratory at the Institute of Experimental Surgical
Devices and Instruments in Moscow (Figs 5 and 6).
Although Brukhonenko was the first to suggest that an
extracorporeal circulation could have a place in cardiac
surgery [25] and applied his heart-lung machine for
clinical resuscitation in the 1950s, the device was never
used in clinical open heart surgery. A success of Gibbon’s
heart-lung machine in the mid-1950s overshadowed
early work of Brukhoneko, and the first heart-lung ma-
chine soon fell into oblivion. From 1958 to 1960, Bruk-
honenko headed the laboratory of Artificial Circulation at
the Institute of Experimental Biology and Medicine.
Brukhonenko died on April 20, 1960.
In 1960, the year of his death, Probert and Melrose
concluded their article on Brukhonenko’s heart-lung ma-
chine as follows: “Brukhonenko’s work demonstrated the
difficulties of total perfusion and went a long way to-
wards resolving them. His technique of excluding the
heart of the perfused animal from the circulation was
crude, but was recognized as a method of achieving
planned cardiac arrest. His writings were clear and
precise in their prophetic insistence that this early work
was applicable to the clinical needs of man” [3].
As we enter a new millennium, a recognition of surgi-
cal pioneers of the century is timely and appropriate.
Brukhonenko died 40 years ago. His work was left unfin-
ished and time has largely forgotten it. He did not see
successful implementation of his heart-lung machine
into clinical practice. Yet, what has been accomplished
does not die. His work assured immortality for his name
and secured its place among the pioneers of cardiac
We are grateful to Lutfia Arifulova, Deputy Director, The Scien-
tific Research Center “Medical Museum” of the Russian Acad-
emy of Medical Sciences, for providing us with documented
information and photographs. We thank Dr Dmitri Tcherkas
and Mr Yuri Rost for their kind help and encouragement.
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Fig 5. Brukhonenko and associates conducting experiments with the
heart-lung machine in 1954. Courtesy of Lutfia Arifulova, Russian
Academy of Medical Sciences.
Fig 6. Brukhonenko with his heart-lung machine in 1954. Courtesy
of Lutfia Arifulova, Russian Academy of Medical Sciences.
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7. Von Schroder W. Uber die Bildungsstatte des Harnstotts.
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suchungen uber “Bayer 205.” Arch Schiffs und Tropen
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14. Steppuhn O, Zeiss H, Brukhonenko S. Biochemical study of
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ung von “Germanin” (Bayer 205) bei bluttransfusionen.
Munchener Medizinische Wochenschrift 1927;74:1316–7.
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... After conducting further trials, Brukhonenko documented that it should be possible to take over the function of a temporarily stopped heart for a few hours [such as for helping cardiopulmonary bypass during cardiac surgery or venoarterial (VA) ECMO]. 25 26 He performed more than 250 open valve operations, which were the first of their kind. Surgical techniques for creating and correcting tricuspid and mitral valve stenosis and insufficiency-related lesions were invented by Terebinski, and are in use even today. ...
... First, he successfully conducted experiments on perfusion of an isolated head of an animal, and then carried out full-fledged artificial blood circulation in the animal's body. However, "autojector" was unsuitable for clinical practice, because in the years there were no biologically indifferent materials and there were no reliable ways to the blood stabilization [8]. ...
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This chapter presents a literature review on the use of various materials in devices providing gas exchange in artificial (extracorporeal) blood circulation. The issues related to the history of artificial blood circulation systems development are considered. Most of authors have noted the need to avoid direct contact between the gas phase and the blood when the latter is saturated with oxygen. Thus, solid polymer membrane devices have become most common to date. The most promising materials for oxygenator membranes are amorphous fluoropolymers as they have high gas permeability and hemocompatibility. Amorphous poly-perfluoro(2-methyl-2-ethyl-1,3-dioxol) and Teflon AF2400 are the most promising materials for oxygenator membranes as they have a 1.5-2-fold greater hemocompatibility and gas permeability than polydimethylsiloxane. Liquid oxygenators using fluorocarbon liquids as the gas transport medium were also considered. These devices may have a great future, as liquid-liquid systems are “ideal”-they have no direct contact of gas with blood, no diffusion resistance of the membrane, the surface of gas exchange is also the surface of heat exchange.
... However, such machines were not feasible before the discovery of the anticoagulant, heparin in 1916 [9]. A Soviet scientist Sergei Brukhonenko developed a heart-lung machine for total body perfusion in 1926 which was used in experiments with canines [10]. Dr. Clarence Dennis led the team that conducted the first known operation involving open cardiotomy with temporary mechanical takeover of both heart and lung functions on April 5, 1951 at the University of Minnesota Hospital [11]. ...
Cannulation of the aorta is done in order to provide oxygenation and circulatory function through the use of the heart lung machine during cardio-pulmonary bypass (CPB). The nature of the blood flow through the aorta and its ramifications during CPB is mostly linear as compared to the physiological flow, which is pulsatile in nature. This leads to the development of multiple morbidities caused by the development of emboli and atheromas. Perioperative postoperative care is necessitated by these conditions. As such the understanding of the blood flow characteristics is necessitated in order to effectively prevent the formation of emboli and to prevent the "Sandblasting" effect. The authors in this work seek to investigate the nature of blood flow through the aorta under such circumstances. The results obtained show the nature of blood flow in the cannulated aorta as well as the optimum angle of placement of the cannula with respect to the aortic wall.
... Serving as a doctor in the Russian army during the First World War, Sergei Brukhonenko witnessed several deaths due to cardiothoracic injuries. Realising that CPB might have allowed these wounds to be repaired, he went on to develop a prototype machine, known as the 'autojector' 12 . This included two mechanically operated diaphragm pumps and a system of valves. ...
Although Acute Limb Ischemia (ALI) is a relatively common complication in patients supported with peripheral veno-arterial extracorporeal membrane oxygenation (vaECMO), it continues to pose a significant challenge, which can lead to major amputations and increased mortality rates. In this chapter, the pathophysiologic mechanisms and the risk factors for peripheral vaECMO-associated ALI are discussed, whereas clinical assessment and diagnostic strategies are presented. Furthermore, an extensive review of the currently suggested preventive measures and their efficacy is provided. Finally, the currently available operative and endovascular revascularization techniques of a viable, acutely ischemic limb are highlighted.
The history of extracorporeal membrane oxygenation or briefly ECMO is tight to the history of cardiac surgery. Among the many individuals who have shaped the history of ECMO, two in particular deserve to be singled out by name. The first person is the surgeon John Gibbon, who spent 20 years of his life researching the possibility of an extracorporeal lung and circulatory support with his wife. He lived in the first half of the last century and he is credited with the first open heart surgery using a heart–lung machine. The second late half of the last century was marked by Robert Bartlett, who still lives in Michigan, USA and is still actively involved in several research projects at the University of Michigan at the Extracorporeal Life Support Laboratory. In this chapter all other important points of the history of ECMO are presented including the most important randomized trials.
A new generation of extracorporeal artificial organ support technologies collectively known as extracorporeal life support (ECLS) devices are being developed for diverse applications to include acute support for trauma-induced organ failure, transitional support for bridge to organ transplant and terminal support for chronic diseases. Across applications, one significant complication limits use of these life-saving devices: thrombosis, bleeding and inflammation caused by foreign-surface induced blood interactions. To address this challenge, transdisciplinary scientists and clinicians look to the vascular endothelium as inspiration for development of new biocompatible materials for ECLS. Here we describe clinically approved and new investigational biomaterial solutions for thrombosis such as immobilized heparin, nitric oxide-functionalized polymers, "slippery" non-adhesive coatings, and surface endothelialization. We describe how hemocompatible materials could abrogate the use of anticoagulant drugs during ECLS and by doing so radically change treatments in critical care. Additionally, we examine several special considerations for the design of biomaterials for ECLS, including: 1) preserving function of the artificial organ, 2) longevity of use and 3) multifaceted approaches for the diversity of device functions and applications.General review article - level of evidence not required.
Erst die Anwendbarkeit der Herz-Lungen-Maschine (HLM) hat die routinemäßige und sichere Durchführung von Operationen am Herzen ermöglicht. Während der Operation übernimmt die HLM die Funktionen von Herz und Lunge (cardiopulmonary bypass, CPB). Dabei zirkuliert das Blut außerhalb des Körpers in einem geschlossenen künstlichen Kreislauf (extrakorporale Zirkulation, EKZ bzw. extracorporeal circulation, ECC). Die HLM ist gegenwärtig, trotz Off-Pump-Techniken und der Zunahme interventioneller Verfahren, als unverzichtbares Standardverfahren aus den herzchirurgischen Operationssälen nicht wegzudenken. Der sichere Einsatz erfordert eine gute Vorbereitung, ausreichende technische Kenntnisse und die sachgerechte Anwendung. Für den eigentlichen Betrieb und die intraoperative Überwachung der HLM ist primär der Kardiotechniker verantwortlich, aber auch der Chirurg muss über fundierte Kenntnisse der HLM-Funktion und ihre technischen Komponenten verfügen, um etwa Fehler und Probleme rasch bemerken und korrigieren zu können. Dabei sind eine reibungslose Kommunikation und ein unmissverständliches Zusammenspiel zwischen dem Chirurgen, dem Kardiotechniker und dem Anästhesisten unerlässlich. Zwischenfälle sind beinahe immer durch mangelnde Vorbereitung, Unachtsamkeit, Verwechslungen oder andere Missverständnisse verursacht.
Deep hypothermic perfusionless circulatory arrest was the first practical neuroprotective technique used for open-heart surgery. It was refined at the Novosibirsk Medical Research Center in Siberia and was actively used from the mid-1950s until 2001.This review describes the development of this technique and its contribution to our understanding of the dynamic changes in human physiology during induced hypothermia for circulatory arrest without extracorporeal perfusion. Deep hypothermic perfusionless circulatory arrest was an important stepping stone in the development of modern approaches in neuroprotection and monitoring during cardiac surgery.