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Does flow character of cardiopulmonary bypass make a difference?
Y A Louagie1, M Gonzalez, E Collard
1Division of Cardiovascular and Thoracic Surgery, University Hospital of Mont-Godinne (Catholic University of Louvain), Yvoir, Belgium.
The Journal of Thoracic and Cardiovascular Surgery
|December 1, 1992
Summary
Pulsatile perfusion (PP) and standard non-pulsatile perfusion (NP) during coronary artery bypass grafting yield similar cardiovascular performance and organ function. However, pulsatile perfusion was associated with increased hypotension requiring vasoconstrictors.
Area of Science:
- Cardiovascular Surgery
- Cardiopulmonary Bypass Technology
- Hemodynamics
Background:
- Standard cardiopulmonary bypass uses non-pulsatile flow, which may affect organ function.
- Pulsatile perfusion aims to mimic physiological blood flow patterns.
- The impact of pulsatile perfusion on various physiological parameters requires further investigation.
Purpose of the Study:
- To compare the effects of pulsatile perfusion (PP) versus standard non-pulsatile perfusion (NP) on cardiovascular performance, fluid balance, acid-base equilibrium, and splanchnic function during coronary artery bypass grafting.
- To assess the safety and efficacy of pulsatile bypass flow in cardiac surgery.
Main Methods:
- A randomized controlled trial involving 100 patients undergoing elective coronary artery bypass grafting.
- Patients were divided into two groups: standard non-pulsatile perfusion (NP) and pulsatile perfusion (PP).
- Key hemodynamic parameters, fluid balance, blood loss, urine output, and organ function markers (creatinine, amylase, lipase clearance, acid-base balance) were monitored and compared between groups.
Main Results:
- Both NP and PP groups demonstrated similar improvements in cardiac performance post-bypass, with no significant difference in left ventricular stroke work index.
- Post-bypass hemodynamics, including mean arterial pressure and systemic vascular resistance, were comparable between groups.
- Pulsatile perfusion was associated with a higher incidence of severe hypotension requiring vasoconstrictors (20% vs. 6%) and lower urine output during bypass (p=0.028).
- Fluid balance, blood loss, and renal/pancreatic function markers showed no significant differences between the two perfusion methods.
Conclusions:
- Pulsatile perfusion and standard non-pulsatile perfusion provide equivalent cardiovascular hemodynamics and organ protection during coronary artery bypass grafting.
- Both methods achieve good control of fluid balance and acid-base equilibrium.
- Pulsatile perfusion necessitates closer monitoring for hypotension and potential need for vasoconstrictive agents.