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Pulsatile perfusion during cardiopulmonary bypass procedures in neonates, infants, and small children
Alan R Rider1, Robert S Schreiner, Akif Undar
1Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania 17033-0850, USA.
Insights
Pulsatile perfusion in pediatric cardiopulmonary bypass (CPB) offers superior hemodynamic energy delivery, enhancing vital organ blood flow and recovery. Optimizing circuit components maximizes these benefits, though further research is needed for full validation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Cardiopulmonary bypass (CPB) is critical for pediatric congenital heart defect surgeries.
- The debate on pulsatile versus nonpulsatile perfusion in CPB persists.
- Understanding hemodynamic principles is key to optimizing CPB outcomes.
Purpose of the Study:
- To evaluate the benefits of pulsatile perfusion over nonpulsatile perfusion in pediatric CPB.
- To highlight the role of energy equivalent pressure and surplus hemodynamic energy.
- To emphasize the impact of extracorporeal circuit components on pulsatility.
Main Methods:
- Measurement of pulsatile flow using energy equivalent pressure and surplus hemodynamic energy.
- Analysis of pediatric patient outcomes with different perfusion methods.
- Assessment of extracorporeal circuit components (pumps, oxygenators, filters, cannulae) and their effect on hemodynamics.
Main Results:
- Pulsatile perfusion more accurately replicates physiologic heart function compared to nonpulsatile.
- Benefits include increased vital organ blood flow and improved postoperative recovery in pediatric patients.
- Optimal selection of CPB circuit components maximizes pulsatility and hemodynamic energy delivery.
Conclusions:
- Pulsatile perfusion demonstrates clear advantages in pediatric CPB by enhancing hemodynamic energy.
- Careful selection of circuit components is crucial for maximizing pulsatile perfusion benefits.
- Further multi-laboratory research is essential to fully validate these findings in pediatric populations.
Abstract:
Multiple factors influence the outcome of cardiopulmonary bypass (CPB) procedures in pediatric patients with congenital heart defects. The benefit of pulsatile over nonpulsatile perfusion is one such factor that continues to be widely debated among researchers, perfusionists, and surgeons. However, by accurately measuring pulsatile flow in terms of energy equivalent pressure and surplus hemodynamic energy, pulsatile perfusion is clearly seen to replicate the physiologic heart in a manner unparalleled by nonpulsatile perfusion. Studied benefits of pulsatile perfusion in pediatric patients include increased vital organ blood flow and improvement in postoperative recovery. Also, the components of the extracorporeal circuit used in CPB are directly related to pulsatility and have a profound effect on hemodynamics in the circuit and the patient. Therefore, pulsatility and surplus hemodynamic energy delivery to the patient can be maximized by choosing the best performing heart-pumps, oxygenators, arterial filters, and cannulae. Furthermore, in using the most optimal circuit components available, the CPB procedure under pulsatile perfusion can proceed efficiently. Currently, the outcomes resulting from pulsatile perfusion in pediatric and adult patients, as well as animal models, are well documented. However, more multilaboratory efforts are necessary to understand and further validate the benefits of pulsatile perfusion in pediatric patients.
