Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P < 0.01) and a fraction higher energy equivalent pressure (EEP, P = 0.058). The net gain of pulsatile flow, represented by the surplus hemodynamic energy (SHE), was found much higher in the CPB circuit than in patients (P < 0.01). Clinically, there was no difference between the pulsatile and nonpulsatile groups with regard to postoperative acute kidney injury, endothelial activation, or inflammatory response. Postoperative organ function and the duration of hospital stay were similar in the two patient groups. In conclusion, pulsatile CPB with the Rotaflow centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

It is demonstrated that the concept of thermoreversible cross-linking of functionalized maleic anhydride grafted ethylene–propylene (EPM-g-MA) rubber using Diels–Alder chemistry is limited neither to laboratory scale using a solvent route nor to gum rubber. The use of an internal mixer is the first step toward an industrial process, since it greatly reduces the processing time and allows for a solventless process for the furan-functionalization and subsequent bismaleimide cross-linking of EPM rubber. Practical rubber compounds were prepared by mixing thermoreversibly cross-linked EPM with carbon black and mineral oil in the same batch mixer. This resulted in reinforcement of the rubber without affecting the thermoreversible character of the cross-linking. The pendant furan groups of the (non)cross-linked EPM-g-furan interact with the carbon black filler. Finally, crystalline EPM rubber compounds were prepared, which show excellent material properties and property retention over multiple reprocessing cycles.