Impact of Perfusion Modalities on Cerebral Hemodynamics, Organ Injury, and Clinical Outcomes in Acyanotic and Cyanotic Congenital Heart Surgery Patients

Abstract

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)