ATP-content in muscular interstitial fluid during pulsatile and non-pulsatile cardiopulmonary bypass in pigs

The potential benefit of pulsatile flow during cardiopulmonary bypass (CPB) has been discussed extensively, but the debate is still unsettled. Release of intracellular ATP is a useful indicator of cellular damage; we have measured the ATP content in perfusates from muscles in pigs undergoing pulsatile or non-pulsatile CPB for 100 min at 37 degrees C. In 5 pigs the Polystan Pulsatile Pump was used and in 5 pigs a conventional roller pump. 11 pigs served as controls; 6 received heparin like the animals subjected to CPB, whereas the remaining 5 animals were not heparinized. ATP was measured by the firefly luminescence technique. At the start of the CPB or control period the ATP content was very low in all 4 groups. In the non-heparinized controls ATP continued to decrease, whereas in the other 3 groups ATP increased linearly during the 100 min of CPB or control period. It is concluded that, by this method, there was no significant difference between pulsatile and non-pulsatile CPB regarding damage to vascular endothelial or smooth muscle cells. However, heparinization per se caused a marked leakage of blood cells into the extravascular space even after the initial leakage from the cannulation had disappeared. This leakage was enhanced by non-pulsatile but not by pulsatile CPB.