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J Thorac Cardiovasc Surg 2000;119:188
© 2000 Mosby, Inc.

LETTERS TO THE EDITOR

Pulsatile perfusion during cardiopulmonary bypass

David Bregman, MD, FACS, FACC

Thoracic and Cardiovascular Surgery, The Point of Aventura-North Tower, 21205 Yacht Club Dr, PH 3205
Aventura, FL 33180

To the Editor:

I read with interest the article by Kawahara and associates from Saitama, Japan, titled "Induced Pulsatile Perfusion During Cardiopulmonary Bypass Does Not Improve Brain Oxygenation" (J Thorac Cardiovasc Surg 1999;118:361-6). The article should be retitled "Balloon Pump–Induced Pulsatile Perfusion During Cardiopulmonary Bypass Does Not Alter Brain Oxygenation" because, as applied in this study, there were no substantial effects of the balloon pump on any of the measured parameters.

Perhaps this is because the balloon did not augment the pulse pressure significantly enough (24 ± 8 mm Hg) during cardiopulmonary bypass. Had the pulse pressure been 40 mm Hg or more, positive readings might have occurred. No hemodynamic blood pressure tracings accompanied the article.

One clear measurement of intra-aortic balloon pump efficacy during cardiopulmonary bypass is the simple measurement of urinary output during successful pulsatile augmentation. ManyGo Go 1,2 studies have shown that when pulsatile flow is successfully applied, the urinary output usually doubles. Was this the case in this study?

Rather than suggest that the lack of improvement in brain oxygenation was a result of the negative (or no) effect of pulsatile perfusion, perhaps the authors should reexamine the basic application of the balloon pump in the cardiopulmonary bypass setting for the creation of pulsatile flow to determine whether it was really applied effectively in their study.

References

  1. Bregman D, Bowman FO Jr, Parodi EN, Haubert SM, Edie RN, Spotnitz HM, et al. An improved method of myocardial protection with pulsation during cardiopulmonary bypass. Circulation 1997;56(Suppl):II157-60.
  2. Haubert SM, Parodi EN, Bregman D. Clinical experience with a new pulsatile cardiac assist device. J Extracorp Circ 1977;9:22.




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