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Physiologic
Pulsatile Flow Advantages ► “Pulsatility (physiologic) has a key role in the
microcirculation” “Role of Pulsatility
in the Microcirculation”
Circulation 2006;114:II 221 ► “The beneficial effects of (physiologic) pulsatile
perfusion occur at the microcirculation; the extra energy required is distributed there, and it maintains capillary bed patency” “The PPP
was chosen because it produces more physiologic pulsatile
flow than the other pumps” Global and Regional
Cerebral Blood Flow in Neonatal Piglets Undergoing Pulsatile
Cardiopulmonary Bypass With Continuous Perfusion at 25°C and Circulatory Arrest
at 18°C Perfusion 2001:16:503-510 Physiologic
Pulsatile Flow Maintains Capillary Bed Patency PPP Historic Experiment – First Total Physiologic
Support 25 kg Dog
▲ 2-Chambers ▲Oxygenation - Animal’s Lungs Controls were set
to duplicate body system; then hands off for 3 hours
Results ► Pulse pressure pattern perfectly
sustained – No variation ► Full flow and ► Kidney function, urine output normal ► No lung edema or pulmonary hypertension ► No
measurable hemolysis (blood damage) - No clotting Conclusion Accurate
Physiologic Pulse Pressure Patterns Has Great Flow
Advantages for Major
Vital Organs and Capillaries Evaluation of a Physiologic Pulsatile
Pump System for Neonate-Infant Cardiopulmonary Bypass Support Akif
Undar, et al; Congenital Heart Surgery Service, Texas Children’s Hospital… ASAIO
Journal 1999; 45:53-58 An alternate physiologic pulsatile
pump (PPP) system was designed and evaluated to produce sufficient pulsatility during neonate-infant open heart surgery. This hydraulically driven pump system
has a unique “dual” pumping chamber mechanism…. Every year, approximately 10,000 neonates
are born in the Complex
surgeries can be done with routine techniques with a lower mortality rate than
ever before, but organ injury (brain, heart, and kidneys) after CPB is still a
significant problem (among 10-30% of postoperative pediatric heart
patients). The mode of perfusion (pulsatile versus nonpulsatile)
may be one of the important factors for organ injury during and after CPB.
Conclusions: -The hydraulically driven physiologic pulsatile pump with a 10 French DLP aortic cannula and arterial filter produced adequate pulsatility in
this neonatal piglet
model -The ECCP was
significantly lower than in any other known pulsatile
pump system. -No regurgitation or
abnormal hemolysis has been observed during
these experiments -The oxygenator
had no damping effect on the quality of pulsatility
because of the dual chamber pumping mechanism This physiologic pulsatile
pump system is the only pump currently used for CPB that has this particular
characteristic. It can be also used
for ECMO, left or right heart assist, bridge to transplant, and organ
preservation experiments. |
