This current review describes how components of the cardiopulmonary bypass (CPB) circuit are selected and examines the benefits of pulsatile perfusion for use during CPB. Pulsatile flow generates significantly greater surplus hemodynamic energy (SHE) than nonpulsatile flow; higher SHE values have been associated with better microcirculation perfusion, lower rates of systemic inflammatory response, and better vital organ protection. Pulsatile perfusion may have a positive effect on clinical outcomes, play a role in preserving homeostasis, and help to decrease morbidity associated with CPB.
HoffmanJKaplanS.. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890–1900.
2.
NieminenHSairanenHTikanojaT. Long-term results of pediatric cardiac surgery in Finland: education, employment, marital status, and parenthood. Pediatrics. 2003;112:1345–1350.
3.
WernovskyGShillingfordAJGaynorJW.. Central nervous system outcomes in children with complex congenital heart disease. Curr Opin Cardiol. 2005;20:94–99.
4.
HainesNWangSÜndarAAlkanAAkcevinA.. Clinical outcomes of pulsatile and non-pulsatile mode of perfusion. J Extra Corpor Technol. 2009;41:P26–P29.
5.
AkçevinAAlkan-BozkayaTQuiFÜndarA.. Evaluation of perfusion modes on vital organ recovery and thyroid hormone homeostasis in pediatric patients undergoing cardiopulmonary bypass. Artificial Organs. 2010;34:879–884.
6.
ÜndarA.. Pulsatile vs nonpulsatile cardiopulmonary bypass procedures in neonates and infants: from bench to clinical practice. ASAIO J. 2005;51;:vi–x.
7.
AlkanTAkçevinAÜndarATürkogluHPakerTAytaçA.. Benefits of pulsatile perfusion on vital organ recovery during and after pediatric open heart surgery. ASAIO J. 2007;53:651–654.
8.
WangSHainesNÜndarA.. Quantification of pressure-flow waveforms and selection of components for the pulsatile extracorporeal circuit. J ECT. 2009;41:P20–P25.
9.
HainesNWangSKunselmanAMyersJÜndarA.. Comparison of pumps and oxygenators with pulsatile and nonpulsatile modes in an infant cardiopulmonary bypass model. Artif Organs. 2009;33:993–1001.
10.
ÜndarAEichstaedtHMasaiT. Comparison of six pediatric cardiopulmonary bypass pumps during pulsatile and non-pulsatile perfusion. J Thorac Cardiovasc Surg. 2001;122:827–829.
11.
RiderAResslerNKarkhanisTKunselmanAWangSÜndarA.. The impact of pump settings on the quality of pulsatility. ASAIO J. 2009;55:100–105.
12.
ÜndarAJiBLukicB. Comparison of hollow-fiber membrane oxygenators with different perfusion modes during normothermic and hypothermic CPB in a simulated neonatal model. Perfusion. 2006;21:381–390.
13.
RiderAJiBKunselmanAWeissWMyersJÜndarA.. A performance evaluation of eight geometrically different 10 Fr pediatric arterial cannulae under pulsatile and nonpulsatile perfusion in an infant cardiopulmonary bypass model. ASAIO J. 2008;54:306–315.
14.
ÜndarA.. Myths and truths of pulsatile and non-pulsatile perfusion during acute and chronic cardiac support [editorial]. Artif Organs. 2004;28:439–443.
15.
SalavitabarAQiuFKunselmanAÜndarA.. Evaluation of the Quadrox-I neonatal oxygenator with an integrated arterial filter. Perfusion. In press; doi:10.1177/0267659110380773.
16.
ShepardRSimpsonDSharpJ.. Energy equivalent pressure. Arch Surg. 1966;93:730–740.
17.
WangSMillerAMyersJÜndarA.. “Stolen” blood flow: effect of an open arterial filter purge line in a simulated neonatal CPB model. ASAIO J. 2008;54:432–435.
18.
RogersonAGuanYKimatianS. Transcranial Doppler ultrasonography: a reliable method for monitoring pulsatile flow during cardiopulmonary bypass in infants and young children. J Thorac Cardiovasc Surg. 2010;139:e80–e82.
19.
DayJRTaylorKM.. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg. 2005;3:129–140.
20.
UmsteadTLuCKFreemanW. Dual-platform proteomics study of plasma biomarkers in pediatric patients undergoing cardiopulmonary bypass. Pediatr Res. 2010;67:641–649.
21.
AgirbasliMNguyenMWinK. Inflammatory and hemostatic response to cardiopulmonary bypass in pediatric population: feasibility of seriological testing of multiple biomarkers. Artif Organs. 2010;34:987–995.
