Coronary flow distribution and dynamics during continuous and pulsatile extracorporeal circulation in the pig

Four extracorporeal perfusion conditions (continuous beating, continuous fibrillating, pulsatile beating, and pulsatile fibrillating) were tested for 15 minutes each in pigs. Coronary flow, endocardial-epicardial flow ratio, phasic coronary flow, myocardial oxygen consumption, and myocardial lactate extraction were measured. No significant differences in any of these variables were found between pulsatile and continuous flow states in either fibrillating or beating hearts (p greater than 0.05). In both fibrillating conditions, significant elevations of myocardial oxygen consumption and decreases in endocardial-epicardial flow ratios were found (p less than 0.05). Lactate extraction occurred in all conditions, and phasic coronary flows were similar in both beating conditions. These data suggest caution in the expectation that pulsatile perfusion will reverse the coronary flow and myocardial oxygen consumption changes seen with fibrillation.