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J Thorac Cardiovasc Surg 2000;119:189-190
© 2000 Mosby, Inc.

LETTERS TO THE EDITOR

Balloon pump–induced pulsatile perfusion during cardiopulmonary bypass does not improve brain oxygenation

Yuji Kadoi, MD, Shigeru Saito, MD

Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, 3-39-22, Showa-machi
Maebashi, Gunma 371-8511, Japan

Reply to the Editor:

We appreciate the interest and comments of Drs Ündar and Fraser. Several investigatorsGo 1 have tried to establish common criteria for pulsatile flow, but it is not clear which type of pulsatile waveform has positive effects on cerebral circulation and improves outcome of patients.Go 2 As stated by Ündar and associates,Go 3 it is impossible to compare the results of different investigations in which different types of pulsatility were used.

We can see that the concept of energy equivalent pressure introduced by Shepard, Simpson, and SharpGo 4 is useful for understanding the quality of pulsatile perfusion. WrightGo 5 believes that hemodynamic considerations were fundamental to resolve the controversy of the pulsatility waveform. We hope that further clinical investigations will determine the best pulsatile form and will be supported by logical theories, such as energy equivalent pressure.

References

  1. Lodge AJ, Under K, Daggett CW, Runge TM, Calhoon JH, Ungerleider RM. Regional blood flow during pulsatile cardiopulmonary bypass and after circulatory arrest in an infant model. Ann Thorac Surg 1997;63:1243-50.[Abstract/Free Full Text]
  2. Hornick P, Taylor K. Pulsatile and nonpulsatile perfusion: the continuing controversy. J Cardiothorac Vasc Anesth 1997;11:310-5.[Medline]
  3. Ündar A, Calhoon JK, Cossman RM, Johnson SB. The effects of pulsatile cardiopulmonary bypass on cerebral and renal blood flow in dogs [letter]. J Cardiothorac Vasc Anesth 1998;12:126-7.[Medline]
  4. Shepard RB, Simpson DC, Sharp JE. Energy equivalent pressure. Arch Surg 1966;93:730-40.[Medline]
  5. Wright G. Hemodynamic analysis could resolve the pulsatile blood flow controversy. Ann Thorac Surg 1994;58:1199-1204.[Abstract]




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