Affects of pulsatile and nonpulsatil exstracorporeal blood circulation technics on postoperative haemodynamic and biochemical result and postoperative clinic survey

ABSTRACT Introduction: In our study; we aimed to investigate the effects of extracorporeal circulation with pulsatile (p) and nonpulsatil (np) flow forms on the hemodynamics, laboratory results, hospital stay, mortality and morbidity rates of cardiac surgery. Materials and methods: Our study was performed in a total of 174 patients who underwent open heart surgery with extra corporeal circulation between May 2015 and May 2017 at Denizli Tekden Hospital Cardiovascular Surgery Clinic based on retrospective file analysis. Patients with an 18-year-old, LVEF value ≥ %40 and cross-clamp time ≥ 60 min who underwent open heart surgery in the presence of an extra corporeal circulation system were included. Patients with renal insufficiency, COPD, history of cardiac surgery, death in the first 12 hours postoperatively, and patients using alcohol and drugs were excluded from the study. Findings: A total of 174 patients were enrolled, 96 (%55.2) of whom were male and 78 (%44.8) were female. The patients were divided into two groups, nonpulsatile (Group I) and pulsatile (Group II). There was no statistically significant difference between the sexes and ages (p = 0.285, p = 0.441, respectively). Mean left ventricular ejection fraction (LVEF) in Group II was significantly higher than Group I (p = 0.001). Mean cross-clamp and total pump durations of Group II were significantly higher than Group I (p <0.001). In Group II, AST and blood gas lactate increase was higher than Group I (p <0.001). In our study, blood gas lactate and AST levels, which are indicators of perfusion deterioration in the pulsatile group with long cross-clamp time, showed a significant increase compared to the nonpulsatile perfusion group.We think that this increase in the markers of perfusion deterioration in the pulsatile group is related to the cross clamp and the duration of the pump, which are prolonged from the pulsatile difference. The prolongation of clamp and pump time is usually related to the type of surgical procedure, the difficulty, and the characteristics of the patient, and this is the preferred reason for the pulsatile operation of the physician performing the surgical procedure in patients who are likely to have a long or long postoperative complication. In this study, it was considered unexpected that the difference in pulsatility caused this situation. Conclusion: In pulsatile perfusion CPB, the duration of cross-clamp, tissue hypoperfusion, and hospital stays were found to be higher than nonpulsatile CPB. There is a need to reduce the duration of CPB and to have large, prospective and randomized studies of pulsatile currents in selected eligible patients. Keywords: bypass, extra corporeal circulation, nonpulsatile perfusion, pulsatile perfusion.