title: Protective effects of pulsatile flow during cardiopulmonary bypass.
abstract: BACKGROUND
  Children with congenital heart disease are often operated at a very young age. Cardiopulmonary bypass (CPB) has become indispensable for these sometimes very complex operations, but one cannot neglect a possible negative impact of CPB on organ function. Traditionally, CPB was developed with non-pulsatile flow but there are clinical observations that pulsatile flow might be superior with improved patient outcomes. Therefore, we attempted to elucidate whether CPB with pulsatile flow preserves organ integrity compared with nonpulsatile flow.
  
  
  METHODS
  We studied 27 piglets of 4 weeks age and divided them into 3 experimental groups: control group (no CPB); non-pulsatile and pulsatile-CBP with 90-minutes CPB and 120-minutes recovery and reperfusion. Thereafter, histology of kidney, liver, and hippocampus was performed. Moreover, we measured adenosine triphosphate (ATP) content in these organs.
  
  
  RESULTS
  Histologic evaluation revealed that laminar flow produced significant cellular edema in the kidney and hippocampus. Additionally, markers for hypoxia, apoptosis, and nitrosative stress were elevated but predominately in the hippocampus and proximal tubules of the kidney. Most of these alterations were reduced to or near control levels with pulsatile CPB. Moreover, ATP content of all 3 organs examined was higher and kidney and liver enzymes were lower in the pulsatile group compared with the non-pulsatile CPB. With regard to histologic changes, the liver seemed to be a less sensitive organ.
  
  
  CONCLUSIONS
  In our study during pulsatile CPB, organ damage was significantly attenuated as compared with non-pulsatile CPB. Therefore, in pediatric patients pulsatile CPB may improve clinical outcomes.
authors.affiliation: Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany. Electronic address: aida.salameh@med.uni-leipzig.de.
authors.forename: Aida
authors.initials: A
authors.lastname: Salameh
authors.affiliation: Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Lydia
authors.initials: L
authors.lastname: Kühne
authors.affiliation: Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Grassl
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Gerdom
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Sandy
authors.initials: S
authors.lastname: von Salisch
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Vollroth
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Clinic for Pediatric Cardiology, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Dähnert
authors.affiliation: Clinic for Cardiac Surgery, University of Leipzig, Heart Centre, Leipzig, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Dhein
mesh_terms: D000818:Animals; D001927:Brain Diseases / Q000209:etiology / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods*; D006624:Hippocampus; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011673:Pulsatile Flow; D013552:Swine