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Three Decades of Evidence on Pulsatile Cardiopulmonary Bypass in Pediatrics: No Significant Clinical Benefit

Akif Ündar1,2,3,4, Marc J Lussier1, Srihari Rajesh1

  • 1Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Hershey, PA, USA.

World Journal for Pediatric & Congenital Heart Surgery
|February 4, 2026
PubMed

Insights

Pulsatile cardiopulmonary bypass (CPB) shows no significant clinical benefits for pediatric patients with congenital heart defects. While not harmful, this technique does not improve short-term or long-term outcomes compared to nonpulsatile flow.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • Extensive expertise in in-vitro, in-vivo, and clinical trials informs this research on pulsatile cardiopulmonary bypass (CPB).
  • Over 30 years of experience guide the analysis of pulsatile CPB's role in pediatric cardiac surgery.

Purpose of the Study:

  • To evaluate the efficacy and clinical outcomes of pulsatile cardiopulmonary bypass (CPB) in pediatric and neonatal patients.
  • To synthesize evidence from peer-reviewed studies on optimizing CPB circuitry for pulsatile flow in young patients.

Main Methods:

  • Conducted a comprehensive literature search of PubMed using keywords: "Pulsatile flow," "Cardiopulmonary Bypass," "Vital Organ Injury," "Clinical outcomes," "Pediatrics," "Neonates and infants."
  • Analyzed 88 peer-reviewed studies published between 1996 and 2025, including randomized clinical trials and retrospective analyses.
  • Included data from a randomized clinical trial of 159 patients and a retrospective study of 284 patients at Penn State Health Children's Hospital.

Main Results:

  • Neonatal piglet models showed improved cerebral hemodynamics with pulsatile flow and deep hypothermic circulatory arrest.
  • Randomized clinical trials and retrospective studies questioned the efficacy of pulsatile flow in clinical settings.
  • A rigorous randomized trial (159 patients) and retrospective study (284 patients) found no significant clinical advantage of pulsatile over nonpulsatile flow.
  • Pulsatile flow did not demonstrate measurable benefits but also did not result in adverse outcomes in clinical trials.

Conclusions:

  • Current evidence indicates that pulsatile cardiopulmonary bypass (CPB) does not offer significant short-term or long-term advantages for pediatric patients undergoing congenital heart surgery.
  • While pulsatile CPB is not associated with adverse outcomes, its clinical utility in this population remains unproven.
  • Further research may be needed to identify specific subgroups or conditions where pulsatile flow might confer benefits.

Keywords:
CPB circuitscardiopulmonary bypassclinical outcomescongenital heart surgeryneonates and infantspediatricspulsatile and nonpulsatile flowvital organ injury

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