Effects of perfusion mode on regional and global organ blood flow in a neonatal piglet model.
BACKGROUND
Organ injury (brain, kidney, and heart) has been reported in up to 30% of pediatric open heart surgery patients after conventional hypothermic non-pulsatile cardiopulmonary bypass (CPB) support with or without deep hypothermic circulatory arrest (DHCA). The effects of pulsatile (with a Food and Drug Administration approved modified roller pump) versus non-pulsatile perfusion on regional and global cerebral, renal, and myocardial blood flow were investigated during and after CPB with 60 minutes of DHCA in a neonatal piglet model.


METHODS
Piglets, mean weight 3 kg, were used in both pulsatile (n = 7) and non-pulsatile (n = 7) groups. After initiation of CPB, all animals were subjected to hypothermia for 25 minutes, reducing the rectal temperatures to 18 degrees C, 60 minutes of DHCA followed by 10 minutes of cold reperfusion and 40 minutes of rewarming with a pump flow of 150 mL/kg/min. During cooling and rewarming, alpha-stat acid-base management was used. Differently labeled radioactive microspheres were injected pre-CPB, on normothermic CPB, pre-DHCA, post-DHCA, and after CPB to measure the regional and global cerebral, renal, and myocardial blood flows.


RESULTS
Global cerebral blood flow was significantly higher in the pulsatile group compared to the non-pulsatile group at normothermic CPB (100.4 +/- 6.3 mL/100 gm/min versus 70.2 +/- 8.1 mL/100 gm/min, p < 0.05) and pre-DHCA (77.2 +/- 5.2 mL/100 gm/min versus 56.1 +/- 6.7 mL/100 gm/min, p < 0.05). Blood flow in cerebellum, basal ganglia, brain stem, and right and left cerebral hemispheres had an identical pattern with the global cerebral blood flow. Renal blood flow appeared higher in the pulsatile group compared to the non-pulsatile group during CPB, but the results were statistically significant only at post-CPB (94.8 +/- 9 mL/100 gm/min versus 22.5 +/- 22 mL/100 gm/min, p < 0.05). Pulsatile flow better maintained the myocardial blood flow compared to the non-pulsatile flow after CPB (316.6 +/- 45.5 mL/100 gm/min versus 188.2 +/- 19.5 mL/100 gm/min, p < 0.05).


CONCLUSIONS
Pulsatile perfusion provides superior vital organ blood flow compared to non-pulsatile perfusion in this model.
Undar
A
A
Congenital Heart Surgery Service, Texas Children's Hospital, Houston 77030-2399, USA. aundar@bcm.tmc.edu
Masai
T
T
Yang
S Q
SQ
Goddard-Finegold
J
J
Frazier
O H
OH
Fraser
C D
CD
D000818:Animals; D000831:Animals, Newborn; D001783:Blood Flow Velocity / Q000502:physiology; D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology; D002315:Cardiopulmonary Bypass; D002648:Child; D006324:Heart Arrest, Induced; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007511:Ischemia / Q000209:etiology* / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply*; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D011673:Pulsatile Flow / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D013552:Swine