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PRINCIPLES AND PRACTICES OF PULSATILE PERFUSION IN PEDIATRIC AND ADULT OPEN-HEART SURGERY
PRINCIPLES AND PRACTICES OF PULSATILE PERFUSION IN PEDIATRIC AND ADULT OPEN-HEART SURGERY
1Departments of Pediatrics, Surgery, and Bioengineering, Penn State College of Medicine, Penn State Childrenfs Hospital, Hershey, Pennsylvania, USA
During the past decade, the mortality rates following pediatric and adult cardiopulmonary bypass (CPB) procedures have been significantly reduced. But, the morbidity is still a significant clinical problem. Particularly, high-risk cardiac patients suffer cerebral, renal, and myocardial dysfunction after CPB. Several investigations now focus on research in minimizing the adverse effects of CPB in high-risk patients. The mode of perfusion (pulsatile or non-pulsatile) has a direct impact on vital organ recovery. Modern perfusion pumps provide the option of pulsatile and non-pulsatile flow. Despite the growing evidence for the possible benefits of pulsatile flow, the majority of institutions still choose to use non-pulsatile flow. The reasons for not using pulsatile flow relate to controversies and lack of sufficient evidence. These will be addressed in this editorial. In addition, step-by-step guidelines for the use of pulsatile flow in clinical patients for future investigations will be described. Particularly, the quantification of pressure-flow waveforms in terms of energy equivalent pressure and total hemodynamic energy levels, different types of pulsatile and non-pulsatile pumps, and the pressure drops seen in membrane oxygenators and aortic cannulas will be included.
Keywords : Pulsatile flow, non-pulsatile flow, cardiopulmonary bypass
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