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Benefits of pulsatile flow in pediatric cardiopulmonary bypass procedures: from conception to conduction
1Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania 17033-0850, USA. aundar@psu.edu
Insights
Pulsatile flow in cardiopulmonary bypass (CPB) requires optimizing all circuit components, not just the pump. Further research is needed to quantify hemodynamic energy gradients for accurate perfusion mode comparisons.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- The debate on the benefits of pulsatile flow in cardiopulmonary bypass (CPB) has persisted for over 55 years.
- Understanding the factors influencing pulsatility generation within CPB circuits is crucial.
Purpose of the Study:
- To review the benefits of pulsatile flow using experimental and clinical data.
- To elucidate the reasons behind the ongoing debate regarding pulsatile flow in CPB.
- To emphasize the necessity of translational research for optimizing CPB components.
Main Methods:
- Review of experimental and clinical data on pulsatile flow.
- Analysis of factors contributing to pulsatility generation in CPB circuitry.
- Discussion on the importance of hemodynamic energy gradients.
Main Results:
- Adequate pulsatility generation depends on the quality of every CPB circuit component, not solely the pump.
- Precise quantification of hemodynamic energy levels is essential for understanding pulsatile flow.
- Comparisons between perfusion modes require prior establishment of energy gradients and circuit optimization.
Conclusions:
- Optimizing all components of the cardiopulmonary bypass circuit is vital for achieving adequate pulsatile flow.
- Translational research is necessary to identify optimal circuit components.
- Future clinical trials are suggested to further investigate perfusion modes.
Abstract:
This review on the benefits of pulsatile flow includes not only experimental and clinical data, but also attempts to further illuminate the major factors as to why this debate has continued during the past 55 years. Every single component of the cardiopulmonary bypass (CPB) circuitry is equally important for generating adequate quality of pulsatility, not only the pump. Therefore, translational research is a necessity to select the best components for the circuit. Generation of pulsatile flow depends on an energy gradient; precise quantification in terms of hemodynamic energy levels is, therefore, a necessity, not an option. Comparisons between perfusion modes should be done after these basic steps have been taken. We have also included experimental and clinical data for direct comparisons between the perfusion modes. In addition, we included several suggestions for future clinical trials for other interested investigators.
