title: Effects of pulsatile and nonpulsatile perfusion on vital organ recovery in pediatric heart surgery: a pilot clinical study.
abstract: The use of pulsatile flow during cardiopulmonary bypass (CPB) with regard to improved patient outcomes is controversial. We evaluated pulsatile perfusion in pediatric patients undergoing CPB in a clinical setting. Fifty consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 25) or the nonpulsatile perfusion group (group NP, n = 25). Study parameters included intubation time, duration of intensive care unit (ICU) stay and hospital stay, need for inotropic support, preoperative and postoperative enzymes, creatinine, C-reactive protein, blood count, mean urine output, and total drainage. Group P, compared with group NP, had significantly less inotropic support (number of agents, 1.48 +/- 1.05 versus 2.44 +/- 1.03, p = 0.0015; dopamine, 6.48 +/- 3.27 versus 10.3 +/- 4.8 microg/kg per minute, p = 0.0023; dobutamine, 3.12 +/- 6.55 versus 8.03 +/- 9.1 microg/kg per minute, p = 0.034), shorter intubation period (20.36 +/- 17.02 versus 35.44 +/- 30.72 hours, p = 0.038), and shorter duration of ICU stay (2.16 +/- 1.07 versus 4.32 +/- 4.21 days, p = 0.028) and hospital stay (7.64 +/- 2.48 versus 11.84 +/- 6.82 days, p = 0.007). There were no significant differences in creatinine, enzyme levels, or drainage amounts between the two groups. Higher urine output during CPB (553.6 +/- 150.89 versus 465.8 +/- 151.23 ml/d, p = 0.045) and during the ICU period (658.8 +/- 210.99 versus 528,2 +/- 224.71 ml/d, p = 0.039) was observed in group P compared with group NP. We concluded that the use of pulsatile flow resulted in improved patient outcome in preserving cardiac function and maintaining better renal and pulmonic function (shorter intubation period) in the early postbypass period.
authors.affiliation: Department of Cardiovascular Surgery, V.K.V. American Hospital, Istanbul, Turkey.
authors.forename: Tijen
authors.initials: T
authors.lastname: Alkan
authors.forename: Atif
authors.initials: A
authors.lastname: Akçevin
authors.forename: Akif
authors.initials: A
authors.lastname: Undar
authors.forename: Halil
authors.initials: H
authors.lastname: Türkoğlu
authors.forename: Tufan
authors.initials: T
authors.lastname: Paker
authors.forename: Aydin
authors.initials: A
authors.lastname: Aytaç
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000502:physiology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000502:physiology; D008168:Lung / Q000502:physiology; D008297:Male; D010865:Pilot Projects; D011673:Pulsatile Flow; D016896:Treatment Outcome