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Precise Quantification of
Pulsatility is a Necessity for Direct Comparisons of Six Different Pediatric
Heart-Lung Machines in a Neonatal CPB Model Akif Undar, Harald C. Eichstaedt, Takafumi
Masai, Joyce E. Bigley, and Allen R. Kunselman Departments of Pediatrics, Surgery, and Bioengineering, Penn State Children’s Hospital, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA; Texas Heart Institute, Houston, TX; and Department of Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA ASAIOJournal
2005; 51:600-603 Abstract: Generation of pulsatile
flow depends on an energy gradient.
Surplus hemodynamic energy (SHE) is the extra hemodynamic energy generated by a pulsatile
device when the adequate pulsatility is
achieved. The objective of this
study was to precisely quantify and compare pressure-flow waveforms in terms of
surplus hemodynamic energy levels of six different
pediatric heart-lung machines in a neonatal piglet model during cardiopulmonary
bypass (CPB) procedures with deep hypothermic circulatory arrest (DHCA). Introduction: Waveforms with a more
physiological morphology contain more energy when compared with less
physiological waveforms at identical pulse pressure, and pump flow rates…. when
there was extra hemodynamic energy …, vital organ
perfusion improved dramatically under pulsatile flow
conditions.
Discussion: There is a direct correlation
between the extra hemodynamic energy levels and vital
organ
recovery under pulsatile flow conditions. Conclusion: The surplus hemodynamic
energy formula is a novel method to precisely quantify
different levels of pulsatility
and nonpulsatility for direct and meaningful
comparisons. PPP - Produced the greatest
surplus hemodynamic energy Pediatric Physiologic Pulsatile Pump Enhances Cerebral and Renal Blood Flow
During and After Cardiopulmonary Bypass Akif Undar, Takafumi Masai, Erik A. Beyer, Jan Goddard-Finegold, Mary Claire McGarry, and Charles D. Fraser, Jr. Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine;
Congenital Heart Surgery Service, Texas Children’s Hospital; Cullen
Cardiovascular Surgical Research Laboratories; Texas Heart Institute; and
Department of Pediatrics and Pediatric Neurology, Baylor College of Medicine,
Houston, Texas Artificial Organs 26(11):919-923 Our study objectives were to first,
quantify pressure and flow waveforms in terms of hemodynamic
energy, using the energy equivalent (EEP) formula, for direct comparisons, and
second, investigate effects of pulsatile versus nonpulsatile flow on cerebral and renal blood flow, and
cerebral vascular resistance during and after CPB with deep hypothermic
circulatory arrest (DHCA) in a neonatal piglet model.
Conclusions: -Pulsatile perfusion improves regional
and global cerebral blood
flow at normothermic CPB and post-CPB compared to the
nonpulsatile perfusion. Renal blood flow was also preserved better with pulsatile
perfusion
and pre-DHCA, post-DHCA, and post-CPB (fourfold) than in the nonpulsatile
group. Cerebral vascular resistance was significantly lower in the pulsatile group than in the nonpulsatile
group at normothermic CPB and after CPB. The physiologic pulsatile pump (PPP) used in this study generated
significantly higher hemodynamic energy than the nonpulsatile roller pump. The EEP formula for
quantification of pressure-flow waveforms is an excellent tool to directly
compare pulsatile and nonpulsatile
perfusion. 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 Akif Undar
et al, Congenital Heart Surgery, Texas Children’s Hospital Perfusion 2001: 16:503-510 The objective of this study was
to investigate the effects of HCPB and circulatory arrest on the regional and global CBF, using a pediatric
physiologic pulsatile pump in a neonatal piglet model. This particular
hydraulically driven, pulsatile pump (PPP) was chosen
for this study because it produces more physiologic pulsatile
flow than the other pulsatile pumps |
