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[Clinical effect of high-flow pulsatile cardiopulmonary bypass in coronary artery bypass grafting]
1Division of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Japan.
Insights
High-flow pulsatile cardiopulmonary bypass (CPB) significantly shortens CPB time and weaning duration. This method, used in coronary artery bypass grafting, showed no increase in mortality or morbidity compared to moderate-flow CPB.
Area of Science:
- Cardiovascular Surgery
- Cardiopulmonary Bypass Technology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) commonly utilizes cardiopulmonary bypass (CPB).
- Optimizing CPB flow rates is crucial for patient outcomes.
- Pulsatile flow is an alternative to conventional non-pulsatile flow during CPB.
Purpose of the Study:
- To evaluate the impact of high-flow pulsatile cardiopulmonary bypass on surgical times and patient outcomes.
- To compare the efficacy and safety of high-flow versus moderate-flow CPB in CABG patients.
Main Methods:
- A study involving 36 patients undergoing CABG.
- Patients were divided into high-flow (3.0 +/- 0.2 l/min/m2) and moderate-flow (2.4 +/- 0.2 l/min/m2) CPB groups.
- Both groups received cold crystalloid cardioplegia, with pulsatile flow and maintained perfusion pressure (50-80 mmHg).
Main Results:
- High-flow CPB group demonstrated significantly shorter CPB and weaning times.
- Urinary output during CPB was significantly higher in the high-flow group.
- No significant differences were observed in postoperative myocardial infarction, stroke, or 30-day mortality between groups.
Conclusions:
- High-flow pulsatile cardiopulmonary bypass is effective in reducing CPB duration.
- This approach does not adversely affect key postoperative morbidity and mortality indicators.
- High-flow pulsatile CPB offers a potential advantage in terms of procedural efficiency for CABG.
Abstract:
The effect of high-flow pulsatile cardiopulmonary bypass was evaluated in 36 patients undergoing coronary artery bypass grafting in our unit. The patients were divided into two groups, based on cardiopulmonary bypass (CPB) flow; high (3.0 +/- 0.2 l/min/m2), or moderate (2.4 +/- 0.2 l/min/m2). Multidose cold crystalloid cardioplegia was administered for myocardial protection. Pulsatile flow during CPB was used and systemic perfusion pressure was maintained between 50 and 80 mmHg. Preoperatively, there were no differences between groups in left ventricular ejection fraction or extent of coronary artery disease. The times required for CPB and weaning from CPB were significantly shorter in high-flow group than moderate-flow group. The urinary output during CPB was significantly higher in high-flow group than moderate-flow group. Postoperatively, there were no significant differences in the incidence of myocardial infarction, stroke, or 30-day mortality between groups. In conclusion, high-flow pulsatile CPB shortens the length of CPB and does not differ significantly from moderate-flow with respect to mortality and morbidity.