Pulsatile versus non-pulsatile flow during cardiopulmonary bypass and its impact on hemostasis

Abstract

Summary. Introduction. Reducing perioperative complications associated with cardiopulmonary bypass (CPB) remains a challenge in cardiac surgery. Recently, there has been an active discussion regarding pulsatile (PF) and non-pulsatile blood flow (NF) during CPB, with a focus on their effects on different laboratory and clinical parameters. Aim: to compare the impact of PF vs. NF during CPB on hemostasis and postoperative complications in early postoperative period. Materials and Methods. A prospective comparative study included 48 cardiac surgery patients randomized into 2 groups according to the blood flow regime during CPB: NF — group 1 (n = 24) and PF — group 2 (n = 24). Von Willebrand factor antigen (vWF) was analyzed at 4 stages: after the induction to anesthesia, at the beginning and at the end of CPB, and 6 hours after CPB. The following plasma hemostasis parameters were measured before and at the end of surgery: prothrombin time (PT), international normalized ratio (INR), prothrombin (Quick test), activated partial thromboplastin time (APTT), and fibrinogen. Postoperative complications were also assessed. Results. At the end of CPB vWF concentration was lower in group 2 (p = 0.011). Six hours after CPB vWF level increased in both

groups (p < 0.05) and were comparable between the groups (p = 0.912). At the end of surgery PT and INR increase and prothrombin (Quick test) and fibrinogen decrease were revealed in both groups (p < 0.01). There was no difference in standard hemostasis parameters between the groups. In group 1 after the surgery PaO2/FiO2 index (the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in the inhaled gas mixture), reflecting the oxygenating lungs function, was lower (p = 0.036), also there was longer duration of vasopressor and inotropic support (p = 0.021); in the case of complications (acute renal failure, acute cerebrovascular accident, acute respiratory failure, need for repeated surgical intervention), re-admission to the intensive care unit was more common (p = 0.049); the number of other compli- cations did not differ between groups. Conclusion. No differences in hemostasis parameters between the groups were found. The changes of vWF concentration were most likely associated with higher endothelial shear stress during PF. Higher PaO2/FiO2 index and shorter duration of inotropic and vasopressor support were revealed in PF group. The volume of drainage discharge, duration of mechanical lung ventilation, stay in the intensive care unit in the early postoperative period and duration of hospitalization did not differ between the groups.

For citation: Dymova O.V., Akselrod B.A., Menshikh N.V., Tolstova I.A., Yudichev I.I., Goncharova A.V., Gladysheva V.G., Guskov D.A. Pulsatile versus non- pulsatile flow during cardiopulmonary bypass and its impact on hemostasis. Tromboz, gemostaz i reologiya. 2025;(4):59–68. (In Russ.).

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