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Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects
Michael P O'Neil1, Jennifer C Fleming, Amit Badhwar
1Department of Surgery, Division of Cardiac Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
The Annals of Thoracic Surgery
|July 28, 2012
Summary
Pulsatile perfusion during cardiopulmonary bypass better preserves microvascular blood flow compared to nonpulsatile flow. This may reduce inflammation and improve outcomes in high-risk cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Hemodynamics
- Microcirculation
Background:
- Optimal perfusion modality during cardiopulmonary bypass (CPB) remains debated.
- This study investigates the impact of pulsatile versus nonpulsatile perfusion on microvascular blood flow during and after CPB.
Purpose of the Study:
- To compare the effects of pulsatile and nonpulsatile perfusion on microvascular blood flow during and after cardiopulmonary bypass.
- To evaluate the impact on systemic inflammatory response and patient outcomes.
Main Methods:
- Randomized trial of high-risk cardiac surgical patients (n=20).
- Patients assigned to pulsatile (n=10) or nonpulsatile (n=10) CPB flow.
- Sublingual microcirculation assessed using orthogonal polarization spectral imaging; hemodynamic and microvascular variables recorded at baseline, during CPB, and post-CPB.
Main Results:
- Pulsatile flow maintained normal microcirculatory patterns throughout CPB and postoperatively.
- Significantly higher proportion of normally perfused microvessels with pulsatile flow (56.0% vs 33.3%; p<0.05).
- Pulsatile flow reduced pathological hyper-dynamic perfusion (6.0% vs 19.6%; p<0.05), decreased leukocyte adherence, and lowered peak postoperative lactate levels.
Conclusions:
- Pulsatile perfusion superiorly preserves microcirculation during CPB.
- Pulsatile flow may attenuate the systemic inflammatory response.
- Implementation of pulsatile flow could optimize microvascular perfusion and improve outcomes in high-risk cardiac surgery.
