Pusatile Perfusion during Cardiopulmonary Bypass (CPB) - No Benefit on Cerebral Perfusion in Adults

I. Guthoff; A. Grassler; B. Mayer; M. Hoenicka; G. Albrecht; R. Bauernschmitt; A. Liebold

doi:10.1055/s-0036-1571641

The Thoracic and Cardiovascular Surgeon, Table of Contents

Pusatile Perfusion during Cardiopulmonary Bypass (CPB) - No Benefit on Cerebral Perfusion in Adults

I. Guthoff ¹, A. Grassler ¹, B. Mayer ², M. Hoenicka ¹, G. Albrecht ¹, R. Bauernschmitt ¹, A. Liebold ¹

¹University of Ulm, Department of Cardio-Thoracic and Vascular Surgery, Ulm, Germany
²University of Ulm, Institute of Epidemiology and Medical Biometry, Ulm, Germany

Abstract

Background: After numerous studies performed in the past, pulsatile perfusion mode was considered unnecessary by the majority of authors. Recently, however, pulsatility revealed beneficial effects on the ratio of t-PA (tissue-type plasminogen activator) and its antagonist, PAI-1 (plasminogen-activator inhibitor) in children undergoing surgery for congenital heart disease. The PAI-1/t-PA - ratio proved to characterize cerebral damage in patients after major stroke. The influence of pulsatile perfusion on these parameters was investigated in adult patients in a randomized, prospective trial.

Methods: 40 patients scheduled for elective or urgent CABG with at least three vessels to be revascularised were randomized to either pulsatile (pp) or continuous (cp) perfusion mode. Patients with preexisting cerebral damage following cerebral events were excluded. For CPB, a miniaturised extracorporeal circulation able to provide pulsatility was used in all cases. Blood samples were taken before, during and after surgery, t-PA and PAI-1 values were determined by ELISA (eBioscience).

Results: The groups were homogenous in terms of gender (pp: 19m, 3f; cp: 15 m,3 f; p = 1) and of age (mean+/ − sd: pp: 64 ± 10 years; cp: 67 ± 8 years, p = 0.35). Perfusion and crossclamp times were 102 ± 19 minute / 57 ± 12 minute and 108 ± 30 / 55 ± 13 minute in pp and cp groups, respectively. In the pulsatile group, pulse pressure amplitude was 24 ± 1.8 mm Hg. Mean arterial pressures were not different between groups (p = 0.66). There was no operative mortality, no patient revealed signs of major or minor stroke after surgery. While there was a significant influence of CPB on the levels of both t-PA and PAI-1 (p< 0.0001), pulsatile perfusion mode did not lead to differences neither in the parameters (t-PA: p = 0.15, PAI-1: p = 0.29) nor in the PAI-1/t-PA - ratio (p = 0.64).

Conclusion: Pulsatile perfusion does not reveal any beneficial effect on cerebral perfusion as characterized by PAI-1/t-PA - ratio. The obvious differences to recently published results in patients undergoing surgery for congenital heart disease may be due to differences in the circulatory physiology and warrant further research.