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Published on: May 11, 2015
Comparison of clinical outcomes between pulsatile and non-pulsatile perfusion during cardiopulmonary bypass: A
Aakriti Sharma1, Prajjwol Luitel2, Prabhat Khakural1
1Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Kathmandu, Nepal.
Insights
Pulsatile perfusion during cardiopulmonary bypass (CPB) showed no significant clinical benefits over non-pulsatile perfusion in elective cardiac surgery. Routine use of pulsatile flow is not recommended based on these findings.
Area of Science:
- Cardiovascular Surgery
- Perfusion Technology
Background:
- The clinical advantages of pulsatile perfusion during cardiopulmonary bypass (CPB) are debated.
- This study investigated the impact of pulsatile versus non-pulsatile perfusion on patient outcomes in elective cardiac surgery.
Purpose of the Study:
- To compare clinical outcomes between pulsatile perfusion (PP) and non-pulsatile perfusion (NP) during CPB.
- To evaluate the efficacy of pulsatile flow in patients undergoing elective cardiac surgery.
Main Methods:
- Eighty patients undergoing elective atrial septal defect (ASD) closure or mitral valve replacement (MVR) were randomized into PP and NP groups.
- Intraoperative management and perioperative protocols were standardized, with pulsatile flow parameters defined for the PP group.
- Outcomes assessed included ICU stay, hospital stay, renal and liver function tests, and complication rates.
Main Results:
- 77 patients were analyzed; groups were similar in demographics and intra-operative variables, with higher baseline creatinine in the pulsatile group.
- No significant differences were observed in ICU stay, hospital stay, liver function, or complication rates between the groups.
- A statistically significant increase in urea levels was noted in the pulsatile perfusion group (p=0.049).
Conclusions:
- Pulsatile perfusion during CPB did not demonstrate significant clinical outcome improvements compared to non-pulsatile perfusion in this cohort.
- The routine use of pulsatile flow in elective cardiac surgery, particularly for ASD closure or MVR in younger patients, cannot be recommended based on these results.
- Further research is needed to explore potential benefits in diverse patient populations and surgical contexts.
Background:
The clinical benefits of pulsatile perfusion during cardiopulmonary bypass (CPB) remain a subject of debate. This study aimed to compare clinical outcomes between pulsatile and non-pulsatile perfusion during CPB in patients undergoing elective cardiac surgery.
Materials And Methods:
Eighty patients undergoing elective atrial septal defect (ASD) closure or mitral valve replacement (MVR) between July 2019 and July 2020 were randomized to two groups: pulsatile perfusion (PP) group and non-pulsatile perfusion (NP) group. All surgeries were performed by a single surgical team. In the PP group, pulsatile flow was maintained at 60-80 per minute for adults and 80-120 per minute for pediatric patients, pulse pressure was maintained higher than 15 mm Hg, while all other intraoperative management and perioperative protocols were kept consistent between groups. The two groups were compared in terms of length of ICU stay, hospital stay, renal function test, liver function test, and complications.
Results:
77 patients with a mean age of 33.8 ± 15.9 were included in the final analysis. The groups were similar in demographics, clinical and intra-operative variables, except body surface area and baseline creatinine, which were higher in the pulsatile group. Length of ICU stay, hospital stay, liver function tests, renal function tests, and complications were similar across both groups, except for higher urea (p-value 0.049) in the pulsatile group.
Conclusions:
This study did not demonstrate significant differences in clinical outcomes between pulsatile and non-pulsatile flow during CPB in elective cardiac surgery. Routine use of pulsatile flow cannot be recommended based on current findings. The study was limited by its restriction to patients undergoing ASD closure or MVR surgery and the dominance of younger patients without major comorbidities.
