Effect of pulsatile and nonpulsatile flow during cardiopulmonary bypass on left ventricular ejection fraction early after aortocoronary bypass surgery

Maddoux, Gerry L.; Pappas, George; Jenkins, Michael; Battock, Dennis; Trow, Richard S.; Smith, Sidney C.; Steele, Peter

doi:10.1016/0002-9149(76)90415-x

Cited by 53 publications

(13 citation statements)

References 45 publications

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“…This clinical finding is in agreement with the results of previous experimental studies, indicating a significant improvement in postperfusion cardiac performance after pulsatile perfusion. [23][24][25] The finding of a reduced requirement for circulatory support, with intra-aortic balloon or inotropic drugs, is in keeping with the overall haemodynamic superiority in the pulsatile group. Bregman26 has reported a similar reduction in the need for postperfusion balloon pumping, and a reduced incidence of perioperative myocardial infarction, in patients perfused with pulsatile flow.…”

Section: Disussionmentioning

confidence: 84%

Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients.

Taylor¹,

Bain²,

Davidson³

et al. 1982

Thorax

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Pulsatile perfusion has been shown to offer significant haemodynamic advantages over non-pulsatile perfusion in many experimental studies. Clinical acceptance of pulsatile perfusion during cardiac surgical procedures has, however, been hampered by the lack of technologically satisfactory pulsatile pump systems, and by inadequate clinical experience of routine use of pulsatile perfusion. The recent introduction of reliable pulsatile pump systems with low haemolysis characteristics has made possible the clinical validation of the previous experimental studies. We describe the results of a prospective study of mortality, haemodynamic morbidity, and haematological status, in 350 consecutive adult patients submitted to cardiopulmonary bypass procedures in a surgical unit over a 12-month period. One hundred and seventy five patients were perfused with conventional non-pulsatile flow and 175 with pulsatile flow, using a modified roller-pump pulsatile system (Cobe-Stockert). The groups were closely similar in terms of preoperative characteristics, referral category, and pathology requiring surgery. Operative techniques, bypass parameters, and anaesthetic regime were standardised in both groups. The results were as follows. (1) Total mortality was significantly lower in the pulsatile group (4.6%) compared with the non-pulsatile group (10.3%), p = 006. (2) The incidence of deaths attributable to post-perfusion low cardiac output was significantly lower in the pulsatile group (11% compared with 6 3 %, p = 0.02). (3) Requirement for mechanical (intra-aortic balloon) or drug circulatory support was significantly lower in the pulsatile group. (4) The use of pulsatile perfusion was not associated with any increase in haemolysis, blood cell depletion, or postoperative bleeding problems.Interest in the clinical applicability of pulsatile perfusion has recently been reawakened, both as a result of the development of reliable, commercially available pump systems and in view of recent clinical research defining more clearly the pathophysiological effects of non-pulsatile perfusion.A prospective clinical study was designed to investigate the clinical applicability of routine pulsatile flow during open-heart procedures, with particular emphasis on the comparative effects of pulsatile and non-pulsatile perfusion on haemodynamic morbidity and mortality statistics. The following specific aims were included in the study.

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Section: Disussionmentioning

confidence: 84%

Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients.

Taylor¹,

Bain²,

Davidson³

et al. 1982

Thorax

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show abstract

“…Randomized study 100 Belgium Effectiveness Driessen et al 53 1995 Randomized study 38 Belgium Effectiveness Murkin et al 55 1995 Randomized study 316 Canada Effectiveness Abramov et al 51 2003 Cohort study 1820 Canada Effectiveness for exclusion were different target population (7 studies), 9,[19][20][21][22] different intervention (6 studies), [23][24][25][26][27][28] outcome of interest was not measured (24 studies), 7,10-12,29-48 and multiple reasons (2 studies). 49,50 Eight studies involving 2503 patients met the inclusion criteria of this review.…”

Section: Resultsmentioning

confidence: 99%

Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach

Alghamdi

Latter

2006

J Cardiac Surgery

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“…There is still an ongoing debate about the benefits of pulsatile perfusion. However, a large number of experimental and clinical works demonstrate an improvement in microcirculation during pulsatile perfusion, probably secondary to a decrease in epinephrine, norepinephrine, and thromboxane production compared with nonpulsatile perfusion . It is well acknowledged that end‐organ recovery depends on the quality of perfusion during mechanical circulatory support.…”

Section: Description Of the Rp06mentioning

confidence: 99%

An Original Versatile Nonocclusive Pressure‐Regulated Blood Roller Pump for Extracorporeal Perfusion

2013

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Currently, only a small number of centrifugal pumps are being used for hemodynamic and/or respiratory support, but all of them have limitations. This article aims to present the Rhône-Poulenc 06 nonocclusive pressure-regulated blood pump. This pump was developed in France in the 1970s and used for decades in perfusion for cardiopulmonary bypass procedures, cardiac or lung assist as well as venovenous bypass during liver transplant. The intrinsic properties of this pump allowed us to describe a new technique for extracorporeal lung support in the 1980s, using a single cannula tidal flow venovenous bypass. This pump compared favorably with conventional pumps in terms of flow and pressure, hemolysis, pulsatility, safety, and cost-effectiveness. We believe that this simple pump could be an alternative to more sophisticated and expensive devices.

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Effect of pulsatile and nonpulsatile flow during cardiopulmonary bypass on left ventricular ejection fraction early after aortocoronary bypass surgery

Cited by 53 publications

References 45 publications

Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients.

Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients.

Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach

An Original Versatile Nonocclusive Pressure‐Regulated Blood Roller Pump for Extracorporeal Perfusion

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