Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1982 May;37(5):324–330. doi: 10.1136/thx.37.5.324

Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients.

K M Taylor, W H Bain, K G Davidson, M A Turner
PMCID: PMC459311  PMID: 7051404

Abstract

Pulsatile perfusion has been shown to offer significant haemodynamic advantages over non-pulsatile perfusion in many experimental studies. Clinical acceptance of pulsatile perfusion during cardiac surgical procedures has, however, been hampered by the lack of technologically satisfactory pulsatile pump systems, and by inadequate clinical experience of routine use of pulsatile perfusion. The recent introduction of reliable pulsatile pump systems with low haemolysis characteristics has made possible the clinical validation of the previous experimental studies. We describe the results of a prospective study of mortality, haemodynamic morbidity, and haematological status, in 350 consecutive adult patients submitted to cardiopulmonary bypass procedures in a surgical unit over a 12-month period. One hundred and seventy five patients were perfused with conventional non-pulsatile flow and 175 with pulsatile flow, using a modified roller-pump pulsatile system (Cobe-Stockert). The groups were closely similar in terms of preoperative characteristics, referral category, and pathology requiring surgery. Operative techniques, bypass parameters, and anaesthetic regime were standardised in both groups. The results were as follows. (1) Total mortality was significantly lower in the pulsatile group (4.6%) compared with the non-pulsatile group (10.3%), p = 0.06. (2) The incidence of deaths attributable to post-perfusion low cardiac output was significantly lower in the pulsatile group (1.1% compared with 6.3%, p = 0.02). (3) Requirement for mechanical (intra-aortic balloon) or drug circulatory support was significantly lower in the pulsatile group. (4) The use of pulsatile perfusion was not associated with any increase in haemolysis, blood cell depletion, or postoperative bleeding problems.

Full text

PDF
329

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bregman D., Bailin M., Bowman F. O., Jr, Parodi E. N., Haubert S. M., Edie R. N., Spotnitz H. M., Reemtsma K., Malm J. R. A pulsatile assist device (PAD) for use during cardiopulmonary bypass. Ann Thorac Surg. 1977 Dec;24(6):574–581. doi: 10.1016/s0003-4975(10)63461-3. [DOI] [PubMed] [Google Scholar]
  2. Cripps C. M. Rapid method for the estimation of plasma haemoglobin levels. J Clin Pathol. 1968 Jan;21(1):110–112. doi: 10.1136/jcp.21.1.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dunn J., Kirsh M. M., Harness J., Carroll M., Straker J., Sloan H. Hemodynamic, metabolic, and hematologic effects of pulsatile cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1974 Jul;68(1):138–147. [PubMed] [Google Scholar]
  4. Estafanous F. G., Tarazi R. C., Buckley S., Taylor P. C. Arterial hypertension in immediate postoperative period after valve replacement. Br Heart J. 1978 Jul;40(7):718–724. doi: 10.1136/hrt.40.7.718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Estafanous F. G., Tarazi R. C., Viljoen J. F., el-Tawil M. Y. Systemic hypertension following myocardial revascularization. Am Heart J. 1973 Jun;85(6):732–738. doi: 10.1016/0002-8703(73)90424-9. [DOI] [PubMed] [Google Scholar]
  6. Gavras H., Kremer D., Brown J. J., Gray B., Lever A. F., MacAdam R. F., medina A., Morton J. J., Robertson J. I. Angiotensin- and norepinephrine-induced myocardial lesions: experimental and clinical studies in rabbits and man. Am Heart J. 1975 Mar;89(3):321–332. doi: 10.1016/0002-8703(75)90082-4. [DOI] [PubMed] [Google Scholar]
  7. Giron F., Birtwell W. C., Soroff H. S., Deterling R. A., Jr Hemodynamic effects of pulsatile and nonpulsatile flow. Arch Surg. 1966 Nov;93(5):802–810. doi: 10.1001/archsurg.1966.01330050106015. [DOI] [PubMed] [Google Scholar]
  8. Hoar P. F., Hickey R. F., Ullyot D. J. Systemic hypertension following myocardial revascularization. A method of treatment using epidural anesthesia. J Thorac Cardiovasc Surg. 1976 Jun;71(6):859–864. [PubMed] [Google Scholar]
  9. Kaplan J. A., Jones E. L. Vasodilator therapy during coronary artery surgery. Comparison of nitroglycerin and nitroprusside. J Thorac Cardiovasc Surg. 1979 Feb;77(2):301–309. [PubMed] [Google Scholar]
  10. Landymore R. W., Murphy D. A., Kinley C. E., Parrott J. C., Moffitt E. A., Longley W. J., Qirbi A. A. Does pulsatile flow influence the incidence of postoperative hypertension? Ann Thorac Surg. 1979 Sep;28(3):261–268. doi: 10.1016/s0003-4975(10)63117-7. [DOI] [PubMed] [Google Scholar]
  11. MANDELBAUM I., BURNS W. H. PULSATILE AND NONPULSATILE BLOOD FLOW. JAMA. 1965 Feb 22;191:657–660. doi: 10.1001/jama.1965.03080080047013. [DOI] [PubMed] [Google Scholar]
  12. Maddoux G., Pappas G., Jenkins M., Battock D., Trow R., Smith S. C., Jr, Steele P. Effect of pulsatile and nonpulsatile flow during cardiopulmonary bypass on left ventricular ejection fraction early after aortocoronary bypass surgery. Am J Cardiol. 1976 Jun;37(7):1000–1006. doi: 10.1016/0002-9149(76)90415-x. [DOI] [PubMed] [Google Scholar]
  13. McQueen M. J., Watson M. E., Bain W. H. Transient systolic hypertension after aortic valve replacement. Br Heart J. 1972 Mar;34(3):227–231. doi: 10.1136/hrt.34.3.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pappas G. A simple method of producing pulsatile flow during clinical cardiopulmonary bypass. Ann Thorac Surg. 1974 Apr;17(4):405–406. doi: 10.1016/s0003-4975(10)65670-6. [DOI] [PubMed] [Google Scholar]
  15. Roberts A. J., Niarchos A. P., Subramanian V. A., Abel R. M., Herman S. D., Sealey J. E., Case D. B., White R. P., Johnson G. A., Laragh J. H. Systemic hypertension associated with coronary artery bypass surgery. Predisposing factors, hemodynamic characteristics, humoral profile, and treatment. J Thorac Cardiovasc Surg. 1977 Dec;74(6):846–859. [PubMed] [Google Scholar]
  16. SONNENBLICK E. H., DOWNING S. E. Afterload as a primary determinat of ventricular performance. Am J Physiol. 1963 Apr;204:604–610. doi: 10.1152/ajplegacy.1963.204.4.604. [DOI] [PubMed] [Google Scholar]
  17. Sanderson J. M., Morton P. G., Tolloczko T. S., Vennart T., Wright G. The Morton-Keele pump--a hydraulically activated pulsatile pump for use in extracorporeal circulation. Med Biol Eng. 1973 Mar;11(2):182–190. doi: 10.1007/BF02478150. [DOI] [PubMed] [Google Scholar]
  18. Stinson E. B., Holloway E. L., Derby G. C., Copeland J. G., Oyer P. E., Beuhler D. L., Griepp R. B. Control of myocardial performance early after open-heart operations by vasodilator treatment. J Thorac Cardiovasc Surg. 1977 Apr;73(4):523–530. [PubMed] [Google Scholar]
  19. Stoelting R. K., Gibbs P. S., Creasser C. W., Peterson C. Hemodynamic and ventilatory responses to fentanyl, fentanyl-droperidol, and nitrous oxide in patients with acquired valvular heart disease. Anesthesiology. 1975 Mar;42(3):319–324. doi: 10.1097/00000542-197503000-00015. [DOI] [PubMed] [Google Scholar]
  20. Taylor K. M., Bain W. H., Maxted K. J., Hutton M. M., McNab W. Y., Caves P. K. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. I. Pulsatile system employed and its hematologic effects. J Thorac Cardiovasc Surg. 1978 Apr;75(4):569–573. [PubMed] [Google Scholar]
  21. Taylor K. M., Bain W. H., Russell M., Brannan J. J., Morton I. J. Peripheral vascular resistance and angiotensin II levels during pulsatile and non-pulsatile cardiopulmonary bypass. Thorax. 1979 Oct;34(5):594–598. doi: 10.1136/thx.34.5.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Taylor K. M., Wright G. S., Bain W. H., Caves P. K., Beastall G. S. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. III. Response of anterior pituitary gland to thyrotropin-releasing hormone. J Thorac Cardiovasc Surg. 1978 Apr;75(4):579–584. [PubMed] [Google Scholar]
  23. Taylor K. M., Wright G. S., Reid J. M., Bain W. H., Caves P. K., Walker M. S., Grant J. K. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. II. The effects on adrenal secretion of cortisol. J Thorac Cardiovasc Surg. 1978 Apr;75(4):574–578. [PubMed] [Google Scholar]
  24. WESOLOWSKI S. A., FISHER J. H., WELCH C. S. Perfusion of the pulmonary circulation by nonpulsatile flow. Surgery. 1953 Mar;33(3):370–375. [PubMed] [Google Scholar]
  25. Wemple R. R., Mockros L. F., Lewis F. J. Pulmonary function during pulsatile and nonpulsatile right heart bypass. J Thorac Cardiovasc Surg. 1969 Feb;57(2):190–202. [PubMed] [Google Scholar]
  26. Zumbro G. L., Jr, Shearer G., Fishback M. E., Galloway R. F. A prospective evaluation of the pulsatile assist device. Ann Thorac Surg. 1979 Sep;28(3):269–273. doi: 10.1016/s0003-4975(10)63119-0. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES