Objectives: New models of centrifugal pumps are claimed to have better hemodynamic performance in pulsatile perfusion during CPB. Few data are available for hemodynamic evaluation of these pumps in vivo, especially in highrisk groups as elderly patients. The study aims at comparing hemodynamic effects of pulsatile versus non-pulsatile perfusion using MEDOS DeltaStream- DP3 centrifugal pump in patients over 75 years old. Methods: Forty patients with severe aortic stenosis (mean age 80.7±3.3, mean EuroScore 5.8±1.4) undergoing AVR from 1.01.2010 to 31.01.2010 were prospectively randomized into pulsatile (n=20pts) and non-pulsatile groups (n=20pts). Pressure and flow curves were recorded simultaneously from external flow-meters (TransonicHT110) and pressure monitor at 6 time points during CPB (at pre-oxygenator, post-oxygenator, aortic cannula and patients radial artery levels). Pulsatility was quantified in terms of Energy Equivalent Pressure(EEP) and Surplus Hemodynamic Energy(SHE). Hemodynamic indexes and clinical effects were monitored during 24 hours peri-operatively. Results: Groups showed no difference in mean CPB time (p=0.98), cross-clamp time (p=0.95), mean perfusion flow (p=0.32) and pressure (p=0.16) values. In both groups the measured blood flow corresponded to the calculated one. Mean SHE generated at the outlet of the pump was 113.5±21.8 ergs/cm3 with further progressive drop along the circuit until 5.3+1.9 ergs/cm3 calculated in the patient (4.7% from initial level). The pulsatile group showed lower vascular resistance during CPB (p=0.035) and significant difference in SVR (p=0.04) and PVR (p=0.02) just after operation. Levels of SHE delivered to the patient correlated positively with urine output during CPB (R=0.34, p=0.041) and PVR after CPB (R=0.44, p=0.015). No differences between groups were found in pharmacologic support, transfusion rates, creatinine levels, respiratory indexes and intubation time. Longer ICU and hospital stay were related to severity of preoperative co-morbidities. Conclusions: Pulsatile flow produced by MEDOS DeltaStream-DP3 centrifugal pump results in hemodynamic advantages and better tissue perfusion in highrisk patients.
Hemodynamic Analysis of Efficacy of Pulsatile Perfusion During Cpb With A New Centrifugal Pump
DODONOV, MIKHAIL;MILANO, Aldo Domenico;FAGGIAN, Giuseppe;TESSARI, Maddalena;MENON, Tiziano;MAZZUCCO, Alessandro
2011-01-01
Abstract
Objectives: New models of centrifugal pumps are claimed to have better hemodynamic performance in pulsatile perfusion during CPB. Few data are available for hemodynamic evaluation of these pumps in vivo, especially in highrisk groups as elderly patients. The study aims at comparing hemodynamic effects of pulsatile versus non-pulsatile perfusion using MEDOS DeltaStream- DP3 centrifugal pump in patients over 75 years old. Methods: Forty patients with severe aortic stenosis (mean age 80.7±3.3, mean EuroScore 5.8±1.4) undergoing AVR from 1.01.2010 to 31.01.2010 were prospectively randomized into pulsatile (n=20pts) and non-pulsatile groups (n=20pts). Pressure and flow curves were recorded simultaneously from external flow-meters (TransonicHT110) and pressure monitor at 6 time points during CPB (at pre-oxygenator, post-oxygenator, aortic cannula and patients radial artery levels). Pulsatility was quantified in terms of Energy Equivalent Pressure(EEP) and Surplus Hemodynamic Energy(SHE). Hemodynamic indexes and clinical effects were monitored during 24 hours peri-operatively. Results: Groups showed no difference in mean CPB time (p=0.98), cross-clamp time (p=0.95), mean perfusion flow (p=0.32) and pressure (p=0.16) values. In both groups the measured blood flow corresponded to the calculated one. Mean SHE generated at the outlet of the pump was 113.5±21.8 ergs/cm3 with further progressive drop along the circuit until 5.3+1.9 ergs/cm3 calculated in the patient (4.7% from initial level). The pulsatile group showed lower vascular resistance during CPB (p=0.035) and significant difference in SVR (p=0.04) and PVR (p=0.02) just after operation. Levels of SHE delivered to the patient correlated positively with urine output during CPB (R=0.34, p=0.041) and PVR after CPB (R=0.44, p=0.015). No differences between groups were found in pharmacologic support, transfusion rates, creatinine levels, respiratory indexes and intubation time. Longer ICU and hospital stay were related to severity of preoperative co-morbidities. Conclusions: Pulsatile flow produced by MEDOS DeltaStream-DP3 centrifugal pump results in hemodynamic advantages and better tissue perfusion in highrisk patients.
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