This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Driessen, J. Articles by Scheistraete, E. Search for Related Content PubMed PubMed Citation Articles by Driessen, J. Articles by Scheistraete, E. Social Bookmarking                         What's this?

Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

H. Dhaese

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

G. Fransen

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

P. Verrolst

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

L. Rondelez

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

L. Gevaert

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

M. van Becelaere

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

E. Scheistraete

Departments of Anaesthesiology and Cardiac Surgery, St Jan's Hospital, Brugge

The present study investigated the influence of pulsatile or nonpulsatile flow delivery with a centrifugal pump for cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in two randomized groups of 19 patients each. All patients received a standard anaesthetic and surgical protocol. Pulsatile perfusion during CPB was created by accelerating the baseline pump speed of the Sarns centrifugal pump at a rate of 50 cycles per minute. Measurements included perioperative systemic haemodynamics and oxygen exchange, total haemolytic complement (CH ₅₀), polymorphonuclear (neutrophil) granulocyte (PMN) count and plasma granulocyte elastase bound to ₁-proteinase inhibitor (E- ₁-PI). Laboratory measurements were corrected for haemodilution. During and after CPB there were only a few significant differences between the groups in systemic haemodynamics and oxygenation, i.e. a lower mean arterial blood pressure after the end of CPB in the nonpulsatile group (65 mmHg, SD = 11 vs 76 mmHg, SD = 11) and a lower S_vO₂ during rewarming on CPB in the nonpulsatile group (62%, SD = 8 vs 67%, SD = 8). The decrease in percentage of PMNs in the total white blood cell count during CPB was greater in the nonpulsatile group than in the pulsatile group (from 61 to 46% vs 63 to 53% of prebypass value). The steep increase of PMN count at the end of CPB and postoperatively was comparable in both groups. The maximal decrease of CH₅₀ levels, occurring after surgery, was significantly higher in the nonpulsatile group (70%, SD = 15 vs 79%, SD = 16, of baseline value), suggesting a greater complement activation. E-₁-PI levels increased significantly in both groups during and after CPB with higher peak levels, obtained at one hour after admission to an intensive care unit, in the nonpulsatile group (316 µg/l, SD = 102) than in the pulsatile group (247 µg/l, SD = 106). There was a partly inverse correlation between the peak postoperative elastase levels and the PaO₂/FiO₂ ratios at the first postoperative morning. This ratio was significantly lower in the nonpulsatile group (211, SD = 56) than in the pulsatile group (247, SD = 62). Postoperative respiratory tract infection was more frequent in the nonpulsatile group (n = 9) than in the pulsatile group (n = 2).

Adding a pulsatile component to centrifugal blood pumping during CPB may have benefits with regard to the possibly detrimental whole body inflammatory response to CPB. Further studies are warranted to investigate whether these differences will affect clinical outcome.

Perfusion, Vol. 10, No. 1, 3-12 (1995)
DOI: 10.1177/026765919501000102


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. S. Murphy, E. A. Hessel II, and R. C. Groom Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach Anesth. Analg., May 1, 2009; 108(5): 1394 - 1417. [Abstract] [Full Text] [PDF]

				C R Valeri, H Macgregor, G Ragno, N Healey, J Fonger, and S F Khuri Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery Perfusion, September 1, 2006; 21(5): 291 - 296. [Abstract] [PDF]

				C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]

				R. Sharony, E. Porat, Y. Nishimura, B. Meyns, S. Ozaki, R. Racz, W. Flameng, and G. Uretzky THE INTRA-AORTIC CANNULA PUMP: A NOVEL ASSIST DEVICE FOR THE ACUTELY FAILING HEART J. Thorac. Cardiovasc. Surg., November 1, 1999; 118(5): 924 - 929. [Abstract] [Full Text] [PDF]

				R Bauernschmitt, E Naujokat, H Mehmanesh, S Schulz, C F Vahl, S Hagl, and R Lange Mathematical modelling of extracorporeal circulation: simulation of different perfusion regimens Perfusion, September 1, 1999; 14(5): 321 - 330. [Abstract] [PDF]

				C. Baufreton, L. Intrator, P. G.M. Jansen, H. te Velthuis, P. Le Besnerais, A. Vonk, J.-P. Farcet, C. R.H. Wildevuur, and D. Y. Loisance Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps Ann. Thorac. Surg., April 1, 1999; 67(4): 972 - 977. [Abstract] [Full Text] [PDF]