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J Thorac Cardiovasc Surg 2001;122:827-829
© 2001 The American Association for Thoracic Surgery

Brief Communications

Comparison of six pediatric cardiopulmonary bypass pumps during pulsatile and nonpulsatile perfusion

From the Congenital Heart Surgery Service,^a Texas Children&'s Hospital; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery,^b Baylor College of Medicine; Cullen Cardiovascular Surgical Research Laboratories,^c Texas Heart Institute; Department of Biostatistics and Epidemiology,^d Texas Heart Institute; and Department of Pediatrics,^e Baylor College of Medicine, Houston, Tex.

This study was supported in part by a grant from the American Heart Association, Texas Affiliate, to Dr Akif Ündar (grant 98BG197).

Received for publication Feb 5, 2001. Accepted for publication Feb 8, 2001. Address for reprints: Akif Ündar, PhD, Texas Children&'s Hospital/Baylor College of Medicine, Congenital Heart Surgery Service, 6621 Fannin St, MC 1-2285, Houston, TX 77030-2399 (E-mail: aundar@bcm.tmc.edu).

Several investigators have shown that pulsatile perfusion improves vital-organ recovery after hypothermic cardiopulmonary bypass (CPB) with or without deep hypothermic circulatory arrest (DHCA). ^1-4 Nevertheless, pulsatile perfusion remains controversial, and only a few pediatric centers use it routinely. ⁵ The main reason for this controversy is lack of quantification of pulsatile and nonpulsatile pressure-flow waveforms. We propose to end the controversy by quantifying pulsatile flow with Shepard&'s energy equivalent pressure (EEP) formula, which accounts for both arterial-pressure and pump-flow waveforms and not pressure waveforms alone. ^6-8 Generation of pulsatile flow depends on an energy gradient rather than on a pressure gradient. The following formula is used to define the EEP:
EEP = (fpdt)/(fdt)
where f is the pump flow rate (in milliliters per second), p is the arterial pressure, and the time integrals are over one pulse cycle. The EEP, which is expressed in millimeters of mercury, is the ratio of the areas beneath the hemodynamic power curve (fpdt) and the pump flow-rate curve (fdt) at the end of the flow and pressure cycles.

To determine whether the pulsatile or nonpulsatile perfusion mode yields the greatest hemodynamic energy during CPB, we evaluated 6 pediatric pumps in terms of the EEP before and after DHCA in a neonatal piglet model.

Experimental design

Thirty-nine piglets (average weight, 3 kg) were subjected to CPB . . . [Full Text of this Article]

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