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Effect of Pulsatile Cardiopulmonary Bypass in Adult Heart Surgery
Ersin Kadiroğulları1, Onur Sen1, Safa Gode1
1Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
Pulsatile flow during cardiopulmonary bypass (CPB) did not improve cerebral oxygen saturation or reduce postoperative complications compared to non-pulsatile flow. Further research is needed to establish pulsatile flow as a routine clinical method.
Area of Science:
- Cardiovascular Surgery
- Hemodynamics
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) is a critical component of cardiac surgery.
- The impact of flow patterns during CPB on patient outcomes remains an area of investigation.
- Optimizing CPB techniques is essential for improving patient recovery and reducing morbidity.
Purpose of the Study:
- To evaluate the effect of pulsatile versus non-pulsatile flow during CPB on cerebral tissue perfusion.
- To assess the influence of different CPB flow patterns on postoperative morbidity and mortality.
- To compare intraoperative physiological parameters between pulsatile and non-pulsatile CPB.
Main Methods:
- Retrospective study of 134 adult patients undergoing cardiac surgery with CPB.
- Patients were divided into non-pulsatile (N=82) and pulsatile (N=52) CPB groups.
- Cerebral oxygen saturation, arterial pH, and lactate levels were measured at four time points; postoperative outcomes were analyzed.
Main Results:
- No significant differences were observed in cerebral oxygen saturation or arterial pH between the groups.
- The non-pulsatile CPB group exhibited significantly higher arterial lactate levels.
- The non-pulsatile CPB group showed increased postoperative drainage, ventilation duration, and hospital stay, but lower blood urea nitrogen.
Conclusions:
- This study does not support the superiority of pulsatile flow during CPB for cerebral oxygenation or postoperative outcomes.
- The findings suggest that pulsatile flow may not offer significant advantages over non-pulsatile flow in this patient cohort.
- Larger comparative studies are recommended to definitively establish the role of pulsatile blood flow in routine clinical practice.
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.
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.
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.
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.
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