Background: Acyanotic and cyanotic congenital heart disease (CHD) patients are known to have distinct operative risk profiles. However, little is known about whether pulsatile and non-pulsatile cardiopulmonary bypass (CPB) have differential effects on cerebral hemodynamics or outcomes in these two patient groups.
Methods: 159 pediatric (age <18 years) cardiac surgery patients were randomized to pulsatile or non-pulsatile CPB. Patients were stratified by type of CHD: acyanotic versus cyanotic. Intraoperative cerebral gaseous microemboli counts and middle cerebral artery pulsatility index were assessed. Postoperative organ injury was quantified by Pediatric-Logistic-Organ-Dysfunction (PELOD-2) score at 24, 48, and 72 hours. Additional outcomes included Pediatric Risk-of-Mortality 3 (PRISM 3) score, vasoactive-inotropic score, duration of mechanical ventilation, intensive care and hospital length-of-stay, and mortality within 180 days.
Results: Regional-cerebral-oxygen-saturation, gaseous microemboli counts, and mean arterial pressure were similar between groups. PELOD-2 scores decreased over time, with similar scores between perfusion modalities in either group. Analysis of additional postoperative outcomes revealed no significant differences between non-pulsatile and pulsatile perfusion in either acyanotic or cyanotic groups.
Conclusions: Despite patients undergoing pulsatile CBP demonstrating a more physiologic pulsatility index in both acyanotic and cyanotic groups, no clinically significant differences in cerebral hemodynamics or clinical outcomes were appreciated.
Trial Registration Number and Registration Date: NCT00862407 (16/03/2009) (first registration date)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.