 I'd like to thank everybody today who are attending the conference in person and very pleased to know that you're being joined by others online and around the country. As we celebrate this our 50th anniversary here of profusion and also the 50 years of profusion innovation and profusion education and research done here at the Texas Heart Institute of profusion technology. Denton A. Cooley completed 59 open heart procedures in 1956 using the DeWall-Lily High oxygen generator, bubble oxygenator, and that's with a finger pump. And if you want to see this in person, it's upstairs in the museum, I rebuilt that pump and it works beautifully. And we also have the old parts of the oxygenator too came out of my garage, some of them. And later he used a so called coffee pot that we, it was found and restored and we put that up there also. It's actually made from restaurant supply items. This coffee pot, the stainless steel sponges were located in the top coated with anti foam a treatment, you would bubble up the blood on the inside the oxygenator. It would go through the stainless steel sponges, the blood would be de phoned, and then the blood was settled into the arterial reservoir. Now as a stainless steel reservoir you couldn't see the operating level so we had a glass tube on the side like a coffee pot. So you can see the operating level. Dr. Cooley actually established the Texas R Institute in 1961. And he and his surgical staff at that particular time had completed 8,673 open heart procedures between 1956 and 1971. He recognized that there was a need for well trained profuseness, or people running the heart and lung machines. We recall pump technicians back in those days to run the heart and lung machines. And in 1971 he hired Charles C. Reed from Ohio State Profusing Department. He was an instructor there. And to become our chief profuseness here at the Texas Heart Institute and the director of the profuseness school at Texas Heart Institute. Dr. Cooley and Charlie established the Profuseness Department and the school in December of 1971. The first profusion class started on January 1972, and they graduated six months later in June 1972. Diane Clark was in that original class of four students. The first four, the students in her class, those four, along with seven other students that followed from the July to December class, participated in 1,759 pump cases, including both adults and pediatrics. Eventually the pediatrics cases were transferred to Texas Children's Hospital. Diane later became the associate director of academics for the profuseness school here, and after she graduated. Then in 1975, Charlie and Diane wrote that textbook of cardiopulmonary perfusion, and she was the co-author of that book. Charlie hired more profuseness in 1973, which is due to the increase in our clinical cases that particular time. I'm here at St. Luke's Episcopal Hospital in Texas Heart Institute, and one of the new employees is Bob Kenan, as seen on the far left there behind Charlie. And Bob was actually a clinical instructor there at Ohio State also, and Bob was hired to become the associate director of the clinical perfusion. A few years later, Bob relocated to the Northwest and then I became the associate director of the clinical department. Charlie and Diane, Charlie, Diane and I extended the length of the program from six months to one year in 1977, because there was an increasing need for profuseness in our around the country. And we also believe that we could enhance our educational opportunities with the additional procedures that we were doing at that particular time. We accepted three volunteers from two classes, two separate classes in June of 1977 and December of 1977 and extended to the one year program that we have. Now we're back to it and again, and now we're back up again. I'm sorry, 18 months. We believed it was a good idea because we had never overlapped our classes before in the past and we thought that these students, so-called senior students could help out our new junior students. As it turned out, it was a good decision because those two overlapping classes of 30 students helped the 10 of us profuseness do 4,074 open heart procedures in 1977. We actually took this slide or this picture, and we made it into a Christmas card for all of our profusion friends around the country. So basically there was $8 pumping cases every day and those cases so we were very fortunate at that time. Now the pioneering efforts of the profuseness from the 1950s and 60s led to what I refer to as our golden era. Those of us that worked in the 70s and 80s because we were in that transition of reusable devices, stainless steel glass, et cetera, and going into disposable cardiopulmonary devices. And we evaluated almost every new device that ever came on the marketplace, including their future revisions. The following devices includes most, but not all of the devices we use for the past 60 years or 50 years. And due to limited time today, I'm not going to show you those slides. I'm sorry, this is not enough time. But many of them can be seen in those textbooks I refer to written by Charlie Reed and co-authored by Diane Clark and Trudy Stafford. So instead this is going to be my reference for the pump, the tubing, filters, oxygenators. Bubble oxygenators included adults and pediatric oxygenators, including from Travinal TMP and we also had a Cooley bag oxygenator. We had stainless steel plates that we put around the outside of the bag for warming and cooling. These disposable oxygenators led to our use of the Bentley, Harvey, Cove, Shelley, the Daco, hard-shelled oxygenators. And there are many revisions over the years. And I'm not aware of any of them being used today. Then we went to membrane oxygenators. For membrane oxygenators, initially we used devices from the Launday Edwards, the Travinal TMO oxygenator and the Symed Colobo Lone. Membranes in various sizes, and again they're no longer available today. But the technology led to the development of other membranes that came with and without soft-shelled reservoirs and hard-shelled venous reservoirs. I mentioned that because the soft-shelled reservoirs or the bags we've referred to them offered us a sense of safety. And because of that, the bags would collapse and prevent you from pumping air. And today we use the hard-shelled reservoirs for simplicity, ease of use, etc. And they came from various companies like Metronik, Bentley, Cove, Shelley, Sorens, Sorens, Perumo, Yoso, Rebeccae, Spectrum, etc. I think it's noteworthy that for myself in the 70s when the TMO was available, I ordered the bracket, the circuit board for the TMO membrane oxygenator. And it took me several months to get it approved. And the reason why is because biomedical engineering refused to approve the electrical circuit board. And I had to explain to them numerous times it was a board, a plastic board, and some brackets used to hold the oxygenator onto the heart-loading machine. Eventually a few months later, they allowed us to use the TMO membrane. Venous reservoirs. Again, we started using the venous reservoir bags with our membrane oxygenators for safety. It's not like an IV bag and it closes when it's empty, but the bubble oxygenators are the same way. Eventually the profusion department did move towards the hard-shelled reservoirs for simplicity. Cardiatomy reservoirs. We initially used non-filtered cardiotomy reservoirs and attached an external depth filters and phone filters and various types of filters, screen filters below the reservoir for additional filtration. A few years later, the manufacturers manufactured the cardiotomy reservoirs with built-in filters inside the reservoir and we used those filters. We did numerous studies used for transfusion, cardiotomy filtration, arterial blood filtration, oxygen and CO2 filtration gas filters, pre-bypass filtration. These studies showed the necessity to use these appropriate filters during and before, during and after cardiopulmonary bypass. I would like to point out that the Texas Heart Institute for Fusion School and the clinical instructors, we did a paper back at that time on pre-bypass filtration. We were the first in the country, the world, to report particulate matter inside the oxygenators. Some of them kind of looked like snowglobes and hence the reason for pre-bypass filtration. Tubing. We used polyvinyl chloride tubing. We used actually a polyvinyl chloride tubing with a polyurethane coating on the inside and silicone tubing. The polyurethane tubing inside coating, that didn't work out so well so eventually it was discontinued. We got the standard PVC polyvinyl chloride and the silicone remain and we also reviewed the use of non-coating and coating tubing that is used today. Monitoring devices. We measured everything in cardiopulmonary bypass. We measured the pre and the post pressure sites of the hemo concentrators, membrane oxidators, arterial filters, water temperature sites, other blood sites. We even monitored the high and low blood levels. We monitored the blood water flows, blood in water flows. We monitored blood gasses, coagulation, etc. The results of these studies led to changes in our perfusion practices. Cardioplasia. Initially, we only delivered crystalloid cardioplasia and degraded, but eventually we did start administering cardioplasia, with and without blood and crystalloid, warm and cold, high and low rates and various temperatures. Canula. We use a wide variety of arterial and venous canyons from various companies. And those canyons were revised to accommodate the size of our patients and also their entry sites. Canula were also redesigned due to the changes in the transition from our exclusive gravity return to kinetic assist venous return and vacuum assist venous return. And that was partly due. Also, there was an increased number of microembolide generated from vacuum assist and etc. from assisted venous return. So that led to more changes in oxygen generated changes in the foamers and filters and the membranes to remove the air from the circuit. Hemoconcentrator. In the mid 70s, I believe that was about the time it may have been the early 70s, we were required to rinse the hemoconcentrators for our pediatric patients and Dr. Romanoli did a wonderful studies on those. Eventually the technology changed and the manufacturers are able to make them pre-wrenched like we're using today in a wide variety of sizes for adults and pediatrics. Auto transfusion. I recall attaching a vacuum to the top of a non-filtered cardiography reservoir, attaching a depth filter below the reservoir, attaching that filter to a roller pump piece of tubing, and we would pull this defone filtered blood and pull it out during these massive blood loss and then we would pump it into an IV bag or blood bag and return it back to the patient for cardiophobic bypass. Somewhere around the mid 70s, I recall one of the first auto transfusion devices came out on the market, I believe it was the hemenetics, it could have been something else, but anyway, we later bought one. So we thought we would try auto transfusion in our cardiac surgery rooms. Well, I tried it for several months for Dr. Cootie's cases and we tried and we tried and we tried, but he never lost enough blood for us to process. So I had to put this auto transfusion device in the closet because it didn't work. We just didn't have any blood to process. And eventually it was removed from the storage room in the late 70s, early 80s, and then they started using auto transfusion devices for a wide variety of procedures and, of course, more surgeons. But I don't recall Dr. Cootie needing them very often and so we adjusted to the times. Metal devices, we cleaned and re-sterilized metal suctions, adult and pediatrics, metal connectors, adult pediatrics, and even the cannula that we were using for our PD and infant cases at that time. Eventually they were replaced with disposable plastic devices in the mid and late 70s, maybe early 80s, all of them were replaced and everything was disposable by then. And it allowed us to do more cases, a lot faster turnaround. Heater coolers, we modified the early Sarn's modular heater coolers to include one of the machines. We actually cut a large hole in the top and then we could put ice in it, but we had to turn off the heater elements on the inside. Well, we mounted these two heater cooler devices side by side, one for cooting, one for warming, and then we wired everything together and we could strategically place clamps on these wide tubing so we could cool, we could re-warm, we could re-circulate whatever was necessary. Now, the nice thing was those were finally discontinued and then newer model heater coolers came out of the market that you use today, like the Sarn's little heater coolers, the Kim Ray, I don't think it had a heating limit on it, I think it went up to about 50 degrees. And the Medtronic and Yosemite, Alpha, Omega, Cincinnati Sub-Zero, the Sarn 3T, and then Cardioquip, so there's a wide variety of these things, but our history helped develop and improve these devices over the year. Roller pumps, we initially used the modular roller pumps and got to use wrenches to adjust for the occlusions and eventually we got the deluxe heads from Sarn's and et cetera, and then we had some console pumps. So we used these modular roller pumps for not just Cardioquip on the bypass, we used them for auto transfusion, you know, remove the blood, defoam it, filter it for the patient. We also used them for ECMO roller pumps and we use them for left heart bypass. I'm sure most of you in this room have never done a left heart bypass with a roller pump, but a few of us have. It's quite a unique experience. So the pumps we did evaluate were like from Sarn's and Trumo, PolyStand. The PolyStand pump was very unique. It was Denmark over there and then it had a verticlu pump that was like a V-type shape and we included things. It was a really nice pump and we used it for a while. And then we've also evaluated and used the Yosemite, the Spectrum, Quantum, et cetera. So we did a short comparison study between pulsatile flow and non-pulsatile flow with the roller pumps, and of course this is using when we're using a bubble oxidative and auto membrane that does change that pulse matter quite a bit. But anyway, our experience with the pulsatile profusion didn't prove to be a significant contribution for cardiopulmonary bypass, and I attribute part of that to the fact that our cases with Dr. Cooley and the odd rule, most of our cases were like 30 minutes, maybe up to an hour. And of course, many of the graduates, like Steve, that graduated, goes to her program, their average bypass time was five hours. And ours was using 30 minutes to an hour and he was not quite prepared for that when he graduated. And he expressed those thoughts to me later. So centrifugal pumps. The first centrifugal pump designed for cardiopulmonary bypass was by Harold Kletzka MD and engineer Edson Rafferty. They successfully tested this device in a laboratory on Dr. Kletzka's sister Barbara. And I've been corresponding quite a bit in the past few years, in part because I was not aware of it, but Dr. Cooley used the very first biopump in 1975. And it was August the 14th, 1975 to be exact. And I saved that pump after the case was over with it was on a 10 year old Jehovah's Witness. That morning we thought we were going to develop. We didn't remind of been a pediatric case Jehovah's Witness did really well. And so I saved it, cleaned it out and I've been using in my lectures for the past 45 years or so. And I think that's probably one of the most significant contributions besides the roller pump is that centrifugal pump the biopump because it led to the design and the development of other companies and their devices for centrifugal pump technology, but we again were the first. That unique pump technology, again, led other companies to designing a variety and updating their centrifugal pumps for cardiopulmonary bypass left heart bypass what a wonderful thought going from roller pumps left heart or centrifugal pumps. And of course egg mode to. And of course these companies came out we're metronic and barred live streamed soaring revolution, Joseph McKay wrote a flow, cp and etc and others. We originally primed our pumps with 20 ccs per kilogram of D five rl Oh, oh goodness, or as low as 800 milliliters. Eventually we did change our primary protocol to consist of the solutions. And we also use 1438 and half inch tubing strategically in the various parts of the circuit to reduce our overall prime. And we have been without blood just like people do today, and eventually other crystalline solutions. It's been rewarding in the past several years to see perfusions bringing back techniques that we use back in the 70s. I like to take this time to comment on a few THI milestones of the profusion school. It was because of the support of our profusion students in 1977. They were the ones that participated in all those cases that particular year, we did more than 4000 pump cases here at Texas Heart Institute with those students from 1977, including these eight or 10 staff. And those same students also contributed to our achieving our 25,000 open heart procedure at Texas Heart Institute. The work for the profusion students in 1983 helped these 15 perfusionists complete more than 4000 open heart procedures of pump procedures. And they also contributed to our achieving 50,000 pump case at Texas Heart Institute. Raymond you're way back in the back of this slide back in the tall guy back in the back near the left, he's over there. There's a lot of good people here. Support from our profusion students in 1983 helped those perfusions like I mentioned in those cases, and in 2001 helped THI to complete their 100,000th procedure. Currently all the profusion students have participated in over 125,000 open heart procedures here at Texas Heart Institute. And my following comments relate to the people who helped manage the program. Before beginning after and at several. I went to work for medical manufacturing and the late 70s or 80s and Diane Clark went to work for hospital administration in 1980. And then she was there was a December 79 graduate and she became the next associate director or academics or associate director 1981. She also co-authored the, the edition, the second edition of cardiopulmonary bypass. I want to point out, it's really not the second edition. That was entirely different title. The first title was cardiopulmonary profusion. This one was cardiopulmonary bypass, but basically it was the second edition. The company I worked for, we also reprinted it in a different color. We went from red to blue. Who knows. This is also important because our students from June of 1980 class and December 1980 class, they, they participated in another major milestone here at Texas Heart Institute. They helped us complete 5,014 open heart pump procedures that one year. In a thousand cases a year and those several rooms that we had was a remarkable task by everyone at that time. And it's the greatest number, I think there's a little over 50 cases in one day. Ray McInnes, and he's here today is as it was a June 1976 graduate. I do need to point out I was not a nice person back in the 70s. And I sense changed. And I attribute part of that to Raymond. He's a nice person. And Charlie was a little bit harder. And Charlie convinced me to push people to the limits one step beyond Raymond was a nicer person. So I take that with hope. Anyway, Raymond was and Charlie was working on that transition of our program from a one year program to a bachelor of science program at the University of Texas Health Center here in Houston. And they're first graduating classes in December of 83. And this is the same year that the students helped us participate in 50,000 open heart case done at Texas Heart Institute. So two remarkable things for Raymond at that time. Now Charlie retired in 1985 and Raymond became the chief profusers and the director of the profusion school. The BS degree was offered from 1883 until about 1985. I'm sorry, 93. And in 93, the UT program decided to reduce the number of allied health care programs. And the THI school of profusion returned to becoming a one year profusion program. And it was approved by the ACP and the K-HOP accrediting agencies, etc. Now Raymond continued his role as a chief profusers and director of the school and treaty continued her role as the associate director, and they did an amazing, a remarkable job when it came to profusion technology and to profusion education. They found other opportunities to pursue in 2002. And I was working for Raymond at that particular time. I'm not sure why he hired me but he did. And I was accepted as their replacement in 2002. I remained the chief profusers here at THI until January of 2012. And this is when the profusion department was transferred to St. Luke's Hospital in the Catholic Health Initiative. I retained the positions director of the school until I retired in 2020. The profusions that St. Luke's and CHI continue to provide the profusion services for the hospital. And they also continue to provide clinical guidance to the students under their clinical affiliate agreement between St. Luke's and THI. The students also gained additional clinical experiences now because they are rotating to other clinical affiliates around the country. I hired Deborah Adams as the associate director of academics in 2016, and Debbie became the director of the school with Kathy Kibler when I retired. And that was in 2020, right after COVID started. Good time for me, huh? Bad time for them. Together, they have expanded the program from one year to 18 months. And everybody will agree they have done an absolutely remarkable job in improving profusion education, especially during the pandemic. This has made an overall positive impact in our profusion community that we've served. I reviewed the 2022 American Board of Cardiovascular Profusion website and found that there are 5,300 certified profusers in the country. I think I counted them correct, but I'm not sure. And in reviewing the names, I found that there were 544 Texas Heart graduates that are still certified. That's about 10% of the market. The American Board also has another category for emeritus status, and I reviewed it. There were 839 profusers under that category, 123 were Texas Heart graduates. That's almost 7% of us retired as a group. I tried to keep up to date on all the THI graduates, and sadly found that there were 47 who passed away in the past 50 years. Before Dr. Cooley passed away, we discussed on many occasions how proud we were of the academic and the clinical education of profusion that our students were receiving here at Texas Heart Institute. And we were very pleased with the adult and the pediatric research done by these students because it was their diligent work that led us to making changes in profusion techniques and inclusion profusion technology. We also found it rewarding to know that our Texas Heart graduates continue to provide academic, clinical, and research support to many cardiac groups around the United States and other countries around the world. I reminded him that part of our success was because they followed his motto. And Dr. Cooley's motto was to modify, simplify, and to apply. I've always tried to encourage students to treat patients as a member of their family or as a friend. And eventually, as they graduate, they would become an extension of the Texas Heart Institute and the clinical rotation sites where they did their work. This was important to me because in the past 50 years, I've had numerous family members and friends that required scheduled and emergent cardiopulmonary bypass or open heart surgery around the country. And I know that my family members and my friends both were getting the best of care no matter where they were because it was either a Texas Heart graduate or graduate from another profusion program and I knew they all did their best. In closing, I'd like to repeat something Dr. Cooley mentioned. That was there are three objectives to the PHI School of Profusion Technology. Those are to provide excellence in patient care, research, and education. What I've also said is the responsibility of the Texas Heart Institute Administration to continue its commitment to the outstanding students and the faculty here at the Texas PHI School of Profusion Technology. The stone heart that you find that you'll see here in front of Texas Heart Institute is referred to as the symbol of excellence. Someone else I forgot to mention earlier and I'd like to thank and that's Joe Bruton for helping me create these slides today. I called him at the last minute and kind of threw them together because I didn't know what I was doing. So thank you Joe. And I would encourage all of you to review the Texas Heart Institute website and go to the profusion section and you can click on that and you can learn more about the school. You'll see photographs of pictures of all of our past graduates for the past 50 years and the research that we're doing. And there's a place you can click on down at the bottom of the thing that you can go back and look at past events and pictures from past events. So again, I'd like to thank everybody for coming today and attending session even online. So thank you very much everybody.