The effects of pulsatile versus nonpulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous microemboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery

Krishna Patel; Yongwook Dan; Allen R Kunselman; Joseph B Clark; John L Myers; Akif Ündar

doi:10.1016/j.xjon.2023.08.013

The effects of pulsatile versus nonpulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous microemboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery

JTCVS Open. 2023 Sep 9:16:786-800. doi: 10.1016/j.xjon.2023.08.013. eCollection 2023 Dec.

Authors

Krishna Patel^{1

2}, Yongwook Dan^{1

2}, Allen R Kunselman^{1

3}, Joseph B Clark^{1

2}, John L Myers^{1

2}, Akif Ündar^{1

2

4}

Affiliations

¹ Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa.
² Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa.
³ Department of Public Health Sciences, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa.
⁴ Department of Biomedical Engineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa.

Abstract

Objective: The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients.

Methods: This retrospective study included 284 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass support utilizing nonpulsatile (n = 152) or pulsatile (n = 132) flow. Intraoperative cerebral gaseous microemboli counts, pulsatility index, and mean blood flow velocity at the right middle cerebral artery were assessed using transcranial Doppler ultrasound. Clinical outcomes were compared between groups.

Results: Patient demographics and cardiopulmonary bypass characteristics between groups were similar. Although the pulsatility index during aortic crossclamping was consistently higher in the pulsatile group (P < .05), a significant degree of pulsatility was also observed in the nonpulsatile group. No significant differences in mean cerebral blood flow velocity, regional cerebral oxygen saturation, or gaseous microemboli counts were observed between the perfusion modality groups. Clinical outcomes, including intubation duration, intensive care unit and hospital length of stay, and mortality within 180 days were similar between groups.

Conclusions: Although the pulsatility index was greater in the pulsatile group, other measures of intraoperative cerebral perfusion and short-term outcomes were similar to the nonpulsatile group. These findings suggest that while pulsatile perfusion represents a safe modality for cardiopulmonary bypass support, its use may not translate into detectably superior clinical outcomes.

Keywords: cardiopulmonary bypass; cerebral hemodynamics; clinical outcomes; congenital heart surgery; gaseous microemboli; pulsatile flow; pulsatility index.