The effects of pulsatile and non-pulsatile cardiopulmonary bypass (CPB) on levels of peripheral vascular resistance and plasma angiotensin II (AII) have been studied in 24 patients submitted to elective cardiac surgical procedures. Twelve patients had conventional non-pulsatile perfusion throughout the period of CPB (non-pulsatile group), while 12 had pulsatile perfusion during the central period of total CPB, using the Stockert pulsatile pump system (pulsatile group). There were no significant differences between the groups in respect of age, weight, bypass time, cross-clamp time, or in mean pump flow or mean perfusion pressure at the onset of CPB. Peripheral vascular resistance index (PVRI) and plasma AII levels were measured at the onset of total CPB and at the end of total CPB. In the non-pulsatile group PVRI rose from 19-6 units to 29-96 units during perfusion. In the pulsatile group PVRI showed little change from 20-89 units to 21-45 units during perfusion (P

Pulsatile perfusion has been shown to offer significant haemodynamic advantages over non-pulsatile perfusion in many experimental studies. Clinical acceptance of pulsatile perfusion during cardiac surgical procedures has, however, been hampered by the lack of technologically satisfactory pulsatile pump systems, and by inadequate clinical experience of routine use of pulsatile perfusion. The recent introduction of reliable pulsatile pump systems with low haemolysis characteristics has made possible the clinical validation of the previous experimental studies. We describe the results of a prospective study of mortality, haemodynamic morbidity, and haematological status, in 350 consecutive adult patients submitted to cardiopulmonary bypass procedures in a surgical unit over a 12-month period. One hundred and seventy five patients were perfused with conventional non-pulsatile flow and 175 with pulsatile flow, using a modified roller-pump pulsatile system (Cobe-Stockert). The groups were closely similar in terms of preoperative characteristics, referral category, and pathology requiring surgery. Operative techniques, bypass parameters, and anaesthetic regime were standardised in both groups. The results were as follows. (1) Total mortality was significantly lower in the pulsatile group (4.6%) compared with the non-pulsatile group (10.3%), p = 006. (2) The incidence of deaths attributable to post-perfusion low cardiac output was significantly lower in the pulsatile group (11% compared with 6 3 %, p = 0.02). (3) Requirement for mechanical (intra-aortic balloon) or drug circulatory support was significantly lower in the pulsatile group. (4) The use of pulsatile perfusion was not associated with any increase in haemolysis, blood cell depletion, or postoperative bleeding problems.Interest in the clinical applicability of pulsatile perfusion has recently been reawakened, both as a result of the development of reliable, commercially available pump systems and in view of recent clinical research defining more clearly the pathophysiological effects of non-pulsatile perfusion.A prospective clinical study was designed to investigate the clinical applicability of routine pulsatile flow during open-heart procedures, with particular emphasis on the comparative effects of pulsatile and non-pulsatile perfusion on haemodynamic morbidity and mortality statistics. The following specific aims were included in the study.

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