Acute and chronic consequences of non-pulsatile blood flow pattern in long-term total artificial heart experiment

Vasků, J; Wotke, Jiří; Dobšák, Petr; Baba, Atsushi; Rejthar, A; Kuchtíčková, Šárka; Imachi, Kou; Abe, Yusuke; Saito, Itsuro; Igarashi, Takashi; Nitta, Shin Ichi; Yambe, Tomoyuki

doi:10.1016/j.pathophys.2007.06.002

Cited by 19 publications

(8 citation statements)

References 25 publications

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“…Previous studies have demonstrated that PP has more positive effects on postoperative recovery of the respiratory system compared with NP, which results in unbalanced flow distribution, compromising peripheral and vital organ circulation. 4 Investigations on tissue perfusion have confirmed advantageous effects of pulsatile pattern, as deduced by the alleviation of systemic inflammatory response after CPB. 5 …”

Section: Introductionmentioning

confidence: 94%

The outcome of pediatric patients undergoing congenital cardiac surgery under pulsatile cardiopulmonary bypass in different frequencies

Li¹,

Jiang²,

Zhang³

et al. 2018

TCRM

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PurposeTo investigate the influence and possible pathophysiological mechanism of pulsatile cardiopulmonary bypass (CPB) in various frequencies in pediatric patients undergoing congenital cardiac surgery.Patients and methodsClinical data and hemodynamic parameters were collected in 80 patients who underwent congenital cardiac surgeries and were perfused in different settings: pulsatile perfusion (PP) in frequencies of 30 beats/min, PP 60 beats/min, PP 100 beats/min and non-pulsatile perfusion (NP). Serum proteins, plasma-free hemoglobin (PFH), endothelin-1 (ET-1) and nitric oxide (NO) were collected to study possible pathophysiological changes, possible hematological injury and oxidative status under different perfusing conditions.ResultsPatients in all groups had similar baseline characteristics, aortic cross-clamping time and CPB duration. More effective pulse gradient (PG), energy-equivalent pressure (EEP) and surplus hemodynamic energy (SHE) were observed in pulsatility with lower frequency setting, under which more patients achieved physiologically normal mean arterial pressure (MAP), without the support of inotropic agents during bypass. Significant between-group differences of serum proteins and PFH were absent the whole time during and after bypass, while a relatively lower percentage of perioperative requirement of diuretics was observed in the low frequency pulsatile group. A better performance to oxidative stress was seen in the low frequency group with higher levels of NO and lower concentration of ET-1, and both intergroup differences were found (P<0.01). Satisfactory clinical outcome was obtained on post procedure course in all groups.ConclusionPulsatile perfusion with low frequency setting in pediatric patients undergoing congenital cardiac surgery showed better hemodynamic profiles, potential protective effects on vital organs, better oxidative status and satisfactory clinical outcome.

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Section: Introductionmentioning

confidence: 94%

The outcome of pediatric patients undergoing congenital cardiac surgery under pulsatile cardiopulmonary bypass in different frequencies

Li¹,

Jiang²,

Zhang³

et al. 2018

TCRM

View full text Add to dashboard Cite

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“…The number of perfused capillaries in the bulbar conjunctiva decreased significantly upon switching from pulsatile to nonpulsatile flow (from 34.7 ± 6.3 to 19.7 ± 4.1 capillaries/mm; P < 0.05) and the velocity of erythrocytes dropped (from 526 ± 83 to 132 ± 41 µm/s; P < 0.05), indicating microcirculatory decline. Histopathologic analysis revealed the presence of chronic venostasis, tissue edema, hemorrhage, hypoxia, and ischemic necroses in tissue samples from liver, kidney, and lung under nonpulsatile flow (45).…”

Section: Total Artificial Heartsmentioning

confidence: 99%

Physiologic Benefits of Pulsatile Perfusion During Mechanical Circulatory Support for the Treatment of Acute and Chronic Heart Failure in Adults

et al. 2010

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A growing population experiencing heart failure (100,000 patients/year), combined with a shortage of donor organs (less than 2200 hearts/year), has led to increased and expanded use of mechanical circulatory support (MCS) devices. MCS devices have successfully improved clinical outcomes, which are comparable with heart transplantation and result in better 1-year survival than optimal medical management therapies. The quality of perfusion provided during MCS therapy may play an important role in patient outcomes. Despite demonstrated physiologic benefits of pulsatile perfusion, continued use or development of pulsatile MCS devices has been widely abandoned in favor of continuous flow pumps owing to the large size and adverse risks events in the former class, which pose issues of thrombogenic surfaces, percutaneous lead infection, and durability. Next-generation MCS device development should ideally implement designs that offer the benefits of rotary pump technology while providing the physiologic benefits of pulsatile end-organ perfusion.

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“…Pulsatile flow is considered more physiological than the nonpulsatile flow, and it has been shown to reduce systemic vascular resistance, preserve microcirculatory perfusion, and protect perioperative lung and renal function during cardiopulmonary bypass (CPB) (2)(3)(4)(5)(6). Thanks to advances in surgical techniques, medical management, and ECLS devices, more and more critically ill patients benefit from successful mechani-cal circulatory and respiratory support.…”

mentioning

confidence: 99%

In Vitro Hemodynamic Evaluation of a Novel Pulsatile Extracorporeal Life Support System: Impact of Perfusion Modes and Circuit Components on Energy Loss

et al. 2015

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The objective of this study is to investigate the impact of every component of extracorporeal life support (ECLS) circuit on hemodynamic energy transmission in terms of energy equivalent pressure (EEP), total hemodynamic energy (THE), and surplus hemodynamic energy (SHE) under nonpulsatile and pulsatile modes in a novel ECLS system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr femoral arterial cannula, a 23/25 Fr femoral venous cannula, and 3/8-in ID arterial and venous tubing. The circuit was primed with lactated Ringer's solution and human whole blood (hematocrit 33%). All trials were conducted under room temperature at the flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 beats per minute and differential speed values of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom-based data acquisition system. EEP was significantly higher than mean arterial pressure in all experimental conditions under pulsatile flow (P < 0.01). THE was also increased under pulsatile flow compared with the nonpulsatile flow (P < 0.01). Under pulsatile flow conditions, SHE was significantly higher and increased differential rpm resulted in significantly higher SHE (P < 0.01). There was no SHE generated under nonpulsatile flow. Energy loss depending on the circuit components was almost similar in both perfusion modes at all different flow rates. The pressure drops across the oxygenator were 3.8-24.9 mm Hg, and the pressure drops across the arterial cannula were 19.3-172.6 mm Hg at the flow rates of 1-4 L/min. Depending on the pulsatility setting, i-cor ECLS system generates physiological quality pulsatile flow without increasing the mean circuit pressure. The iLA membrane ventilator is a low-resistance oxygenator, and allows more hemodynamic energy to be delivered to the patient under pulsatile mode. The 18 Fr femoral arterial cannula has acceptable pressure drops under nonpulsatile and pulsatile modes. Further in vivo studies are warranted to confirm these results.

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Acute and chronic consequences of non-pulsatile blood flow pattern in long-term total artificial heart experiment

Cited by 19 publications

References 25 publications

The outcome of pediatric patients undergoing congenital cardiac surgery under pulsatile cardiopulmonary bypass in different frequencies

The outcome of pediatric patients undergoing congenital cardiac surgery under pulsatile cardiopulmonary bypass in different frequencies

Physiologic Benefits of Pulsatile Perfusion During Mechanical Circulatory Support for the Treatment of Acute and Chronic Heart Failure in Adults

In Vitro Hemodynamic Evaluation of a Novel Pulsatile Extracorporeal Life Support System: Impact of Perfusion Modes and Circuit Components on Energy Loss

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