Clinical Study Of Modified Roll Pump Pulsatile Perfusion In Pediatric Patients Undergoing Cardiopulmonary Bypass Heart Surgery

Objectives To evaluate the role and efficiency of pulsatile perfusion in pediatric complicated congenital heart disease patients undergoing open heart surgery with cardiopulmonary bypass(CPB) and compare the effects on inflammatory factors with nonpulsatile perfusion during CPB. In order to provide the clinic evidence of pulsatile CPB in pediatric heart surgery.Material and Methods Firstly, we established the pulsatile perfusion CPB model in vitro using Jostra HL-20 heart lung machine and made sure the stability of this in vitro model. Then detected the pressure of several sites in the CPB circuit of the model to evaluate the pressure drop of different device in CPB circuit and prepared for clinical feasibility of pulsatile CPB. Dideco Lilliput 902 and Terumo Capiox RX05 oxygenators were selected to compare the oxygenator pressure drop(OPP) in PP study. 24 pediatric patients diagnosed as tetralogy of Fallot were randomized into two groups, pulsatile perfusion (PP) group and nonpulsatile perfusion (NP) group. PP patients (n=12) used modified roll pump pulsatile perfusion during cross clamping period in CPB, while NP cases (n=12) used roll pump flat-flow perfusion during CPB. We choose Fuwai infant's type B circuits and corresponding devices. All patients underwent medium hypothermia or deep hypothermia low flow perfusion during surgery and alpha-stat was performed to manage blood gas during CPB. We monitored hemodynamic status and inflammatory factors (IL-8 and TNF-α) in blood samples over time period in all patients, and detected the effects of different perfusion on hemolysis and pulmonary and renal functions.Results 4 in vitro pulsatile CPB model were completely successful and stable, and pressure monitoring of different sites in CPB circuit was feasible and stable. There is no difference of pulsatile perfusion system between crystalloid solution and pure colloid solution priming. The maximum pressure drop happened in the site of aorta cannula during pulsatile CPB. Capiox RX05 oxygenator created less OPP than Lilliput 902 and Capiox RX05 should be preferred to select in pulsatile perfusion. Effective pulsatile perfusion can be monitored in PP patients and pulse pressure (ΔP) in PP patients can be maintained in 15mmHg to 35mmHg.ΔP was significantly higher in PP group than NP group. In PP patients, IL-8 and TNF-αwere lower after cross clamp off and ICU period than that in NP cases in this study. Free plasma hemoglobin concentration in PP group at pre-clamp off and CPB weaned off were higher than that of NP group . Also urine output was significantly higher in PP group than NP group. there was no difference of ICU intubation time between two groups.Conclusion In vitro pulsatile CPB model established by Jostra HL-20 heart lung machine was a safe and stable system, it can be used to initiate in vitro CPB study in the future. Aortic cannula created the maximum pressure drop during pulsatile CPB and Capiox RX05 will contribute to effectiveness of pulstile perfusion. Pulsatile Perfusion can be successfully and easily performed in pediatric CPB. Pulsatile can reduce the inflammatory response and have potential benefit to microcirculation perfusion and protection of main organs. So we recommend that Pulsatile CPB will be applied in high-risk cyanotic pediatric patients.