Effect of Pulsatile Cardiopulmonary Bypass in Adult Heart Surgery

Abstract

<jats:p>Background: This study aimed to examine the effect of pulsatile flow pattern on tissue perfusion, particularly cerebral tissue perfusion, at pre-determined intervals during CPB, as well as its effects on postoperative morbidity and mortality.&#x0D; Methods: This retrospective study included 134 adult patients, who underwent cardiac surgery with cardiopulmonary bypass (CPB). Patients were grouped based on the flow pattern used during CPB: non-pulsatile CPB group (N = 82) and pulsatile CPB group (N = 52). Cerebral oxygen saturation, arterial pH and arterial lactate levels were measured at four time points, during the operation and the 2 groups were compared with regard to changes over time as well as differences in postoperative outcomes.&#x0D; Results: The 2 groups were similar, in terms of mean values and intraoperative changes in cerebral oxygen saturation and arterial pH. Non-pulsatile CABG group had significantly higher arterial lactate levels over the measurement period, which was not affected by the timing of the measurements. Postoperative drainage, duration of ventilation and duration of hospital stay significantly were higher and postoperative blood urea nitrogen significantly was lower in the non-pulsatile CPB group. Other postoperative outcomes were similar across the groups.&#x0D; Conclusion: Findings of this study do not support the superiority of pulsatile flow pattern during CPB, in terms of cerebral oxygen saturation or postoperative mortality/morbidity. Further and larger comparative studies are warranted before pulsatile blood flow pattern can be established as a routine clinical method.</jats:p>

Pulsatility protects the endothelial glycocalyx during extracorporeal membrane oxygenation

“…9,10 Ündar's group examined the i-Cor system in animal models and had reported better renal function and more stable hemodynamics in pulsatile circuits. 7 The advantages of pulsatile flow have been well-established as it generates more hemodynamic energy and extra-pressure, 11 which improve microcirculatory perfusion 12 and subsequently alleviate systemic inflammatory responses. 13,14 The endothelial function is closely associated with microcirculatory hemostasis, and the microvascular endothelial cell facilitates the microcirculatory metabolism, participating extensively in various pathophysiological processes.…”

Pulsatile versus non-pulsatile perfusion in coronary artery bypass operation: The comparison of laboratory and clinical outcomes

“…19 Contrary to our finding, in an investigation by Kardirogullari et al postoperative arterial lactate level was significantly lower in the pulsatile technique. 24 Despite their results, the authors proposed further investigations with larger sample sizes to confirm the pulsatile perfusion as a routine method in daily practice.…”

Delirium after Cardiac Surgery—A Narrative Review

“…Pulsatile blood flow mimics normal physiologic blood flow, but there is controversy as to whether any significant benefit exists. Evidence suggests it enhances microcirculatory blood flow and tissue perfusion, but no demonstration of superiority to non-pulsatile blood flow on outcomes has been made [18,22]. Evidence also suggests that non-pulsatile blood flow increases carotid artery wall stress, and can lead to shedding of the endothelial glycocalyxa process also involved in systemic inflammation and perfusion-reperfusion injury [23].…”