Journal ArticleDOI
Pulsatile perfusion improves regional myocardial blood flow during and after hypothermic cardiopulmonary bypass in a neonatal piglet model.
Akif Ündar,Takafumi Masai,Shuang Qiang Yang,Harald C. Eichstaedt,Mary Claire McGarry,William K. Vaughn,Charles D. Fraser +6 more
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TLDR
Pulsatile flow generates significantly higher energy, enhancing myocardial flow during and after hypothermic CPB and after 60 minutes of ischemia in this model.Abstract:
Pediatric myocardial related morbidity and mortality after cardiopulmonary bypass (CPB) are well documented, but the effects of pulsatile perfusion (PP) versus nonpulsatile perfusion (NPP) on myocardial blood flow during and after hypothermic CPB are unclear. After investigating the effects of PP versus NPP on myocardial flow during and after hypothermic CPB, we quantified PP and NPP pressure and flow waveforms in terms of the energy equivalent pressure (EEP) for direct comparison. Ten piglets underwent PP (n = 5) or NPP (n = 5). After initiation of CPB, all animals underwent 15 minutes of core cooling (25 degrees C), 60 minutes of hypothermic CPB with aortic cross-clamping, 10 minutes of cold reperfusion, and 30 minutes of rewarming. During CPB, the mean arterial pressure (MAP) and pump flow rates were 40 mm Hg and 150 ml/kg per min, respectively. Regional flows were measured with radiolabeled microspheres. During normothermic CPB, left ventricular flow was higher in the PP than the NPP group (202+/-25 vs. 122+/-20 ml/l 00 g per min). During hypothermic CPB, no significant intragroup differences were observed. After 60 minutes of ischemia and after rewarming (276+/-48 vs. 140+/-12 ml/100 g per min; p < 0.05) and after CPB (271+/-10 vs. 130+/-14 ml/100 g per min; p < 0.05), left ventricular flow was higher in the PP group. Right ventricular flow resembled left ventricular flow. The pressure increase (from MAP to EEP) was 10+/-2% with PP and 1% with NPP (p < 0.0001). The increase in extracorporeal circuit pressure (ECCP) (from ECCP to EEP) was 33+/-10% with PP and 3% with NPP (p < 0.0001). Pulsatile flow generates significantly higher energy, enhancing myocardial flow during and after hypothermic CPB and after 60 minutes of ischemia in this model.read more
Citations
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Journal ArticleDOI
An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and adult cardiac patients.
Bingyang Ji,Akif Ündar +1 more
TL;DR: It is determined that pulsatile flow significantly improved blood flow of the vital organs including brain, heart, liver, and pancreas; reduced the systemic inflammatory response syndrome; and decreased the incidence of postoperative deaths in pediatric and adult patients.
Journal ArticleDOI
Myths and truths of pulsatile and nonpulsatile perfusion during acute and chronic cardiac support.
Journal ArticleDOI
Benefits of pulsatile perfusion on vital organ recovery during and after pediatric open heart surgery.
TL;DR: It is concluded that the use of pulsatile flow resulted in improved patient outcomes in terms of preserving better cardiac, renal, and pulmonary functions in the early post-CPB period.
Journal ArticleDOI
Pediatric physiologic pulsatile pump enhances cerebral and renal blood flow during and after cardiopulmonary bypass.
Akif Ündar,Akif Ündar,Akif Ündar,Takafumi Masai,Erik A. Beyer,Jan Goddard-Finegold,Mary Claire McGarry,Charles D. Fraser,Charles D. Fraser +8 more
TL;DR: Pulsatile flow generates higher hemodynamic energy, enhancing cerebral and renal blood flow during and after CPB with DHCA in this model.
Journal ArticleDOI
Effects of pulsatile CPB on interleukin-8 and endothelin-1 levels.
Akira Sezai,Motomi Shiono,Kin-ichi Nakata,Mitsumasa Hata,Mitsuru Iida,Akira Saito,Tsutomu Hattori,Shinji Wakui,Masao Soeda,Makoto Taoka,Tomofumi Umeda,Nanao Negishi,Yukiyasu Sezai +12 more
TL;DR: In the present study, inhibitory effects on cytokine activity, edema in pulmonary alveoli, and endothelial damage were shown in addition to the favorable effects on catecholamine level, renal function, and peripheral circulation that have already been documented.
References
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Journal ArticleDOI
Energy equivalent pressure.
TL;DR: In this article, the authors describe differences in steady and pulsatile blood flow in terms of an energy equivalent pressure, which is obtained by calculation from phasic flow and pressure measurements.
Journal ArticleDOI
Cardioplegic protection of the child’s heart
TL;DR: Use of a logistic analysis suggested that about half the hospital deaths were attributable to inadequate myocardial preservation despite cardioplegia, and poor scores were predictive of hospital death.
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A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery:: I. mortality and cardiovascular morbidity
TL;DR: In this article, a double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations.
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Effects of perfusion mode on regional and global organ blood flow in a neonatal piglet model.
Akif Ündar,Takafumi Masai,Shuang Qiang Yang,Jan Goddard-Finegold,O.H. Frazier,Charles D. Fraser +5 more
TL;DR: Pulsatile perfusion provides superior vital organ blood flow compared to non-pulsatile perfume in this model and maintains the myocardial blood flow better after CPB.
Journal ArticleDOI
Defining Pulsatile Perfusion: Quantification in Terms of Energy Equivalent Pressure
TL;DR: This definition establishes common criteria for assessment of the effectiveness of extracorporeal support and contains both the arterial pressure and pump flow rate, which are the 2 most critical parameters for open heart surgery.