Clinical application of pulsatile perfusion during cardiopulmonary bypass in pediatric heart surgery.

The benefits of pulsatile over nonpulsatile perfusion has been widely debated in pediatric cardiac operations with cardiopulmonary bypass (CPB). To evaluate the role of pulsatile perfusion in pediatric complicated patients with congenital heart disease undergoing open heart surgery, we performed pulsatile CPB and compared several effects with nonpulsatile perfusion. Pediatric patients (n = 24) diagnosed as typical tetralogy of Fallot (TOF) were randomly divided into two groups: pulsatile perfusion (PP) group and nonpulsatile perfusion (NP) group. Pulsatile perfusion patients used modified roller pump PP during cross-clamping period in CPB, although NP cases used roller pump continuous flow perfusion during CPB. We monitored hemodynamic status and inflammatory media in blood samples over time in all patients. Effective PP can be monitored in PP patients and pulse pressure (DeltaP) was significantly higher in PP group than NP group (p < 0.01). Inflammatory media peaked at the time CPB was weaned off. In PP patients, IL-8 and TNF-alpha were lower after cross-clamp off and intensive care unit period than in NP cases. Free plasma hemoglobin concentration in PP group at preclamp off and CPB weaned off were higher than that of NP group (p < 0.05). Pulsatile perfusion can be successfully applied in pediatric perfusion. Pulsatile perfusion had the role of reducing concentration of inflammatory media in pediatric patients.