Comparison of pulsatile and non-pulsatile cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.
BACKGROUND
Patients with chronic obstructive pulmonary disease have an increased risk of mortality and morbidity after open-heart surgery. This is mostly due to a dysfunction of the pulmonary system during and after non-pulsatile cardiopulmonary bypass. The purpose of this study was to compare the pulsatile and non-pulsatile blood flows during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.


METHODS
This is a prospective study. Ten patients with chronic obstructive pulmonary disease had open-heart surgery with pulsatile flow, and another 9 patients with non-pulsatile flow. We compared clinical, hemodynamic, biochemical and hematological parameters and arterial and venous blood gases before initiating cardiopulmonary bypass, at aortic cross-clamping and de-clamping, and 1 and 24 hours postoperative.


RESULTS
In the pulsatile flow group, systemic vascular resistance at the time of aortic cross clamping (p=0.041), pulmonary vascular resistance 1 hour postoperative (p=0.05), and the percentage of neutrophils 1 hour postoperative (p=0.034) were significantly lower than those of the non-pulsatile group. Though white blood cell count was significantly high in the pulsatile group 1 hour postoperative, absolute neutrophil count was significantly low (p=0.034). The postoperative mechanical ventilation period was significantly shorter in the pulsatile flow group (p=0.016).


CONCLUSIONS
Pulsatile blood flow during cardiopulmonary bypass has a favorable influence on patients with chronic obstructive pulmonary disease, who have high risk in open-heart surgery.
Tarcan
Onurcan
O
Türkiye Yüksek Ihtisas Hospital Cardiovascular Surgery Clinic, Ankara, Turkey. onurcantarcan@hotmail.com
Ozatik
Mehmet Ali
MA
Kale
Arzum
A
Akgül
Ahmet
A
Kocakulak
Mustafa
M
Balci
Mustafa
M
Undar
Akif
A
Kucukaksu
Deniz Suha
DS
Sener
Erol
E
Taşdemir
Oguz
O
D001784:Blood Gas Analysis; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000601:surgery*; D011673:Pulsatile Flow; D018709:Statistics, Nonparametric; D014655:Vascular Resistance