title: Pediatric physiologic pulsatile pump enhances cerebral and renal blood flow during and after cardiopulmonary bypass.
abstract: Controversy over benefits of pulsatile flow after pediatric cardiopulmonary bypass (CPB) continues. Our study objectives were to first, quantify pressure and flow waveforms in terms of hemodynamic energy, using the energy equivalent (EEP) formula, for direct comparisons, and second, investigate effects of pulsatile versus nonpulsatile flow on cerebral and renal blood flow, and cerebral vascular resistance during and after CPB with deep hypothermic circulatory arrest (DHCA) in a neonatal piglet model. Fourteen piglets underwent perfusion with either an hydraulically driven dual-chamber physiologic pulsatile pump (P, n = 7) or a conventional nonpulsatile roller pump (NP, n = 7). The radiolabeled microsphere technique was used to determine the cerebral and renal blood flow. P produced higher hemodynamic energy (from mean arterial pressure to EEP) compared to NP during normothermic CPB (13 +/- 3% versus 1 +/- 1%, p < 0.0001), hypothermic CPB (15 +/- 4% versus 1 +/- 1%, p < 0.0001) and after rewarming (16 +/- 5% versus 1 +/- 1%, p < 0.0001). Global cerebral blood flow was higher for P compared to NP during CPB (104 +/- 12 ml/100g/min versus 70 +/- 8 ml/100g/min, p < 0.05). In the right and left hemispheres, cerebellum, basal ganglia, and brainstem, blood flow resembled the global cerebral blood flow. Cerebral vascular resistance was lower (p < 0.007) and renal blood flow was improved fourfold (p < 0.05) for P versus NP, after CPB. Pulsatile flow generates higher hemodynamic energy, enhancing cerebral and renal blood flow during and after CPB with DHCA in this model.
authors.affiliation: Division of Congenital Heart Surgery, Michael E DeBakey Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston 77030-2399, USA. aundar@bcm.tmc.edu
authors.forename: Akif
authors.initials: A
authors.lastname: Undar
authors.forename: Takafumi
authors.initials: T
authors.lastname: Masai
authors.forename: Erik A
authors.initials: EA
authors.lastname: Beyer
authors.forename: Jan
authors.initials: J
authors.lastname: Goddard-Finegold
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: McGarry
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000367:Age Factors; D000818:Animals; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D007432:Intraoperative Period; D011184:Postoperative Period; D011673:Pulsatile Flow / Q000502:physiology*; D012079:Renal Circulation / Q000502:physiology*; D013552:Swine; D014655:Vascular Resistance / Q000502:physiology