Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass

Abstract

The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. Study parameters included total drainage, mean urine output in the intensive care unit (ICU), intubation time, duration of ICU and hospital stay, the need for inotropic support, pre- and postoperative enzyme levels (ALT [alanine aminotransaminase] and AST [aspartate aminotransaminase]), c-reactive protein, lactate, albumin, blood count (leukocytes, hematocrit, platelets), creatinine levels, and thyroid hormones (thyroid stimulating hormone [TSH], FT(3) [free triiodothyronine], FT(4) [free thyroxine]). All patients survived the perioperative and postoperative periods. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Group P, compared to Group NP, required significantly less inotropic support, had a shorter intubation period, higher urine output in ICU, and shorter duration of ICU and hospital stay. Lower lactate levels and higher albumin levels were observed in Group P and there were no significant differences in creatinine, enzyme levels, blood counts, or drainage amounts between two groups. TSH, Total T(3) , Total T(4) , and FT(3) , FT(4) levels were markedly reduced versus their preoperative values in both groups. FT(3) and FT(4) levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion.

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

“…Second, findings demonstrate that pulsatile flow results in numerically lower decreases in cerebrovascular PI as measured by TCD in the majority of time points measured, with significantly lower decreases at time points between 5 and 40 min after XC, inclusive. At these time points onward, pulsatile flow resulted in a ϳ30% lower decrease in PI compared with nonpulsatile flow, which may promote improved cerebrovascular hemodynamics and recovery (6,7).…”

“…Although current findings suggest that pulsatile flow imparts distinct advantages including increased hemodynamic energy leading to better blood flow to major organs such as brain, movement of lymph that prevents edema and sludging in microcapillaries, maintained microcirculatory flow, improved multiorgan function, and improved organ recovery (6,7), there is little available evidence directly comparing pulsatile and nonpulsatile perfusion with regards to current brain monitoring techniques, CNS protection, and neurodevelopmental outcomes. In particular, comparisons of pediatric patients undergoing pulsatile and nonpulsatile perfusion using near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO 2 ) and transcranial Doppler (TCD) ultrasound to measure cerebrovascular pulsatility index (PI) are not available.…”

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

“…Silitreli et al (11) reported that pulsatile perfusion does not prevent the occurrence of NTIS in comparison to non-pulsatile blood-flow. Somewhat different results were published by Akçevin et al (17) in the study of pediatric patients subjected to cardiac surgery of congenital heart disease with the use of CPB, where pulsatile perfusion during the operation had a certain protective effect on TH homeostasis in comparison to the non-pulsatile technique.…”

Monitoring Biomarkers After Pediatric Heart Surgery: A New Paradigm on the Horizon

“…Previous studies indicate that pulsatile flow during CPB can in fact maintain physiologic thyroid balance . In our pilot study, the thyroid stimulating hormone (TSH) gradually decreased as the patients underwent CPB.…”