ABSTRACT

Although it has been thought that the complications due to non-pulsatile blood flow should decrease with the utilization of pulsatile perfusion during cardiopulmonary bypass (CPB), there is not enough literature about the probable beneficial effects on cerebral perfusion. In this study we aimed to determine whether the utilization of pulsatile or non-pulsatile CPB makes a difference on the cerebral circulation by the measurements of biochemical serum markers and the jugular bulb oxygen saturation (SjVO2) in addition to near- infrared spectroscopy (NIRS).

Eighteen patients scheduled for coronary revascularization on CPB were included in the study. After aortic clamping, non-pulsatile and pulsatile perfusion were both performed for 10-minute periods. S100ß, adrenomedullin (ADM), NSE and SjVO2 measurements were performed 10 minutes before anesthesia, during non-pulsatile perfusion, during pulsatile perfusion and 10 minutes after CPB. Niroxope 401 was used for NIRS measurements.

Fourteen patients were male (77.8 %) and four patients were female (22.2 %). The mean age was 59.06±10.40 and the mean ejection fraction was 50.67 ± 13.39 %. There were no statistical differences between the two perfusion regimes with regard to the mean arterial blood pressures (67.26±7.01/68.71±527 mmHg) and the serum hemoglobin levels (8.64±1.32/8.51±1.29 mg/dl). The postoperative neurocognitive dysfunction rate was 27.8 % and the cerebrovascular event rate was 11.1 %. The increasing values of s100β during non-pulsatile perfusion were decreased significantly with pulsatile perfusion. Off-pump NSE levels and ADM levels during pulsatile perfusion and after CPB were statistically higher. There were no statistical differences between the perfusion types for NSE, SjVO2 and NIRS measurements.

The decrease in s100β levels during pulsatile perfusion is the striking point of this study. We think that there is a need for more studies with extended patient series to prove that the neurologic complications due to CPB should decrease with pulsatile perfusion.