Pulsatile perfusion during cardiopulmonary bypass procedures in neonates, infants, and small children.

Multiple factors influence the outcome of cardiopulmonary bypass (CPB) procedures in pediatric patients with congenital heart defects. The benefit of pulsatile over nonpulsatile perfusion is one such factor that continues to be widely debated among researchers, perfusionists, and surgeons. However, by accurately measuring pulsatile flow in terms of energy equivalent pressure and surplus hemodynamic energy, pulsatile perfusion is clearly seen to replicate the physiologic heart in a manner unparalleled by nonpulsatile perfusion. Studied benefits of pulsatile perfusion in pediatric patients include increased vital organ blood flow and improvement in postoperative recovery. Also, the components of the extracorporeal circuit used in CPB are directly related to pulsatility and have a profound effect on hemodynamics in the circuit and the patient. Therefore, pulsatility and surplus hemodynamic energy delivery to the patient can be maximized by choosing the best performing heart-pumps, oxygenators, arterial filters, and cannulae. Furthermore, in using the most optimal circuit components available, the CPB procedure under pulsatile perfusion can proceed efficiently. Currently, the outcomes resulting from pulsatile perfusion in pediatric and adult patients, as well as animal models, are well documented. However, more multilaboratory efforts are necessary to understand and further validate the benefits of pulsatile perfusion in pediatric patients.