Benefits of Pulsatile Perfusion on Vital Organ Recovery During and After Pediatric Open Heart Surgery

Abstract

Controversy continues concerning the utilization of pulsatile flow during cardiopulmonary bypass (CPB) procedures with regard to improved patient outcomes. We evaluated 215 consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease who were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 151) or the nonpulsatile perfusion group (group NP, n = 64). All patients received identical surgical, perfusional, and postoperative care. Major complications and clinical outcome were documented. There were no statistically significant differences seen in either preoperative or operative parameters between the two groups (age, body surface area, weight, X-clamp and CPB time, base flow, flow rates, and hemofiltration). Group P, compared with group NP, had significantly less inotropic support (number of agents 1.4 +/- 0.07 vs. 2 +/- 0.12, p = 0.0012; dopamine 7.14 +/- 0.28 vs. 9.04 +/- 0.42 microg 32 x kg x min, p = 0.00025; dobutamine 4.12 +/- 0.3 vs. 5.3 +/- 0.6 microg 32 x kg x min, p = 0.036), adrenalin (0.026 +/- 0.005 vs. 0.046 +/- 0.005 microg 32 x kg x min, p = 0.021), shorter intubation period (10.26 +/- 1.04 vs. 18.64 +/- 1.99 hours, p = 0.021), shorter duration of intensive care unit (ICU) (1.53 +/- 0.07 vs. 2.75 +/- 1.19 days, p = 0.012), and hospital stay (6.71 +/- 0.19 vs. 11.16 +/- 0.58 days, p = 0.002). Although there were no significant differences in either creatinine, enzyme levels, and drainage amounts between two groups, lower lactate levels 16.27 +/- 2.02 vs. 24.66 +/- 3.05 mg/dl, p = 0.00034), higher albumine levels (3.15 +/- 0.03 vs. 2.95 +/- 0.06 mg/dl, p = 0.046), and higher urine output (602.82 +/- 21.5 vs. 505.55 +/- 34.2 ml/d, p = 0.016) during ICU period was observed in group P compared with group NP, respectively. We concluded that the use of pulsatile flow resulted in improved patient outcomes in terms of preserving better cardiac, renal, and pulmonary functions in the early post-CPB period.