Effects of Pulsatile and Nonpulsatile Perfusion on Cerebral Regional Oxygen Saturation and Endothelin‐1 in Tetralogy of Fallot Infants

Abstract

Although benefits of pulsatile flow during cardiopulmonary bypass (CPB) in pediatric heart surgery remain controversial and nonpulsatile CPB is still widely used in clinical cardiac surgery, pulsatile CPB must be reconsidered due to its physiologic features. In this study, we aimed to evaluate the effects of pulsatile perfusion (PP) and nonpulsatile perfusion (NP) on cerebral regional oxygen saturation (rSO₂) and endothelin-1 (ET-1) in pediatric tetralogy of Fallot (TOF) patients undergoing open heart surgery with CPB. Forty pediatric patients were randomly divided into the PP group (n = 20) and the NP group (n = 20). Pulsatile patients used a modified roller pump during the cross-clamp period in CPB, while NP patients used a roller pump with continuous flat flow perfusion. The subjects were monitored for rSO₂ from the beginning of the operation until 6 h after returning to the intensive care unit (ICU). We also monitored the hemodynamic status and ET-1 concentration and plasma free hemoglobin (PFH) in blood samples of all patients over time. Effective PP was monitored in PP patients, and pulse pressure was significantly higher in the PP group than in the NP group (P < 0.01). rSO₂ of the PP group was higher than that of the NP group (P < 0.01) during the cross-clamp period, and this advantage of PP would be maintained until 2 h after patients returned to the ICU (P < 0.05). ET-1 level in blood samples was lower at clamping off and CPB weaning and early ICU period in the PP group than in the NP group (P < 0.01), and ET-1 concentration remained at a normal level after patients were transferred to the ICU 24 h in all patients. PFH levels in the PP group at pre-clamp off and CPB weaned off were higher than those of the NP group (P < 0.05) in these cyanotic patients. PP can increase rSO₂ and improve microcirculation during cross-clamping period in TOF pediatric patients, while PP resulted in more severe hemolysis in these cyanotic patients than NP.

Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

“…Although brain perfusion remains constant within a wide range of blood pressure values due to auto-regulative processes, there is some evidence that a more physiological (i.e., pulsatile) flow might be of advantage. In a recently published manuscript Zhao et al a clear advantage of pulsatile flow was described with regard to oxygen saturation as well as an improvement of microcirculation in a study comprising 40 infants with Tetralogy of Fallot undergoing cardiac surgery with either pulsatile or non-pulsatile CPB [59]. A possible disadvantage of the pulsatile roller pumps might be a higher level of hemolysis and possible platelet activation [59].…”

“…In a recently published manuscript Zhao et al a clear advantage of pulsatile flow was described with regard to oxygen saturation as well as an improvement of microcirculation in a study comprising 40 infants with Tetralogy of Fallot undergoing cardiac surgery with either pulsatile or non-pulsatile CPB [59]. A possible disadvantage of the pulsatile roller pumps might be a higher level of hemolysis and possible platelet activation [59]. In contrast, others did not find advantageous effects of pulsatile flow during CPB [60,61].…”

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“…Not only the quantity, but also the quality of these articles generated by this event based on high‐impact factors (average impact factor is greater than 2.7 annually) are also very impressive. Only during the last 2 years' events, topics covered show the clear evidence of the uniqueness and importance of this conference (Table ) .…”

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“…Ju Zhao et al. (61) of Fuwai Cardiovascular Hospital, Beijing, China evaluated the effects of pulsatile perfusion (PP) and nonpulsatile perfusion (NP) on cerebral regional oxygen saturation (rSO 2 ) and endothelin‐1 (ET‐1) in pediatric tetralogy of Fallot (TOF) patients undergoing open heart surgery with CPB. Forty pediatric patients were randomly divided into the PP group ( n = 20) and the NP group ( n = 20).…”