• Michael P O'Neil, Rene Alie, Linrui Ray Guo, Mary-Lee Myers, John M Murkin, and Christopher G Ellis.
• Department of Clinical Perfusion Services, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. Electronic address: michael.oneil@lhsc.on.ca.
• Ann. Thorac. Surg. 2018 Jun 1; 105 (6): 1745-1753.

BackgroundPulsatile perfusion may offer microcirculatory advantages over conventional nonpulsatile perfusion during cardiopulmonary bypass (CPB). Here, we present direct visual evidence of microvascular perfusion and vasoreactivity between perfusion modalities.MethodsA prospective, randomized cohort study of 20 high-risk cardiac surgical patients undergoing pulsatile (n = 10) or nonpulsatile (n = 10) flow during CPB was conducted. Changes in sublingual mucosal microcirculation were assessed with orthogonal polarization spectral imaging along with near-infrared spectroscopic indices of thenar muscle tissue oxygen saturation (StO2) and its recovery during a vascular occlusion test at the following time points: baseline (T0), 30 minutes on CPB (T1), 90 minutes on CPB (T2), 1 hour after CPB (T3), and 24 hours after CPB (T4).ResultsOn the basis of our scoring scale, a shift in microcirculatory blood flow occurred over time. The pulsatile group maintained normal perfusion characteristics, whereas the nonpulsatile group exhibited deterioration in perfusion during CPB (T2: 74.0% ± 5.6% versus 57.6% ± 5.0%) and after CPB (T3: 76.2% ± 2.7% versus 58.9% ± 5.2%, T4: 85.7% ± 2.6% versus 69.8% ± 5.9%). Concurrently, no important differences were found between groups in baseline StO2 and consumption slope at all time points. Reperfusion slope was substantially different between groups 24 hours after CPB (T4: 6.1% ± 0.6% versus 3.7% ± 0.5%), indicating improved microvascular responsiveness in the pulsatile group versus the nonpulsatile group.ConclusionsPulsatility generated by the roller pump during CPB improves microcirculatory blood flow and tissue oxygen saturation compared with nonpulsatile flow in high-risk cardiac surgical patients, which may reflect attenuation of the systemic inflammatory response and ischemia-reperfusion injury.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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