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02 July 2004

Comparison of pulsatile and non-pulsatile cardiopulmonary bypass in patients with chronic obstructive pulmonary disease

Onurcan Tarcan, Mehmet Ali Özatik, Arzum Kale, Ahmet Akgül, Mustafa Kocakulak, Mustafa Balci, Akif Ündar, Deniz Suha Kucukaksu, Erol Sener, Oguz Taşdemir

Med Sci Monit 2004; 10(7): CR294-299 :: ID: 11691

Abstract

Background:Patients with chronic obstructive pulmonary disease have an increased risk of mortality and morbidity after open-heart surgery. This is mostly due to a dysfunction of the pulmonary system during and after non-pulsatile cardiopulmonary bypass. The purpose of this study was to compare the pulsatile and non-pulsatile blood flows during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.Material/Methods:This is a prospective study. Ten patients with chronic obstructive pulmonary disease had open-heart surgery with pulsatile flow, and another 9 patients with non-pulsatile flow. We compared clinical, hemodynamic, biochemical and hematological parameters and arterial and venous blood gases before initiating cardiopulmonary bypass, at aortic cross-clamping and de-clamping, and 1 and 24 hours postoperative.Results:In the pulsatile flow group, systemic vascular resistance at the time of aortic cross clamping (p=0.041), pulmonary vascular resistance 1 hour postoperative (p=0.05), and the percentage of neutrophils 1 hour postoperative (p=0.034) were significantly lower than those of the non-pulsatile group. Though white blood cell count was significantly high in the pulsatile group 1 hour postoperative, absolute neutrophil count was significantly low (p=0.034). The postoperative mechanical ventilation period was significantly shorter in the pulsatile flow group (p=0.016).Conclusions:Pulsatile blood flow during cardiopulmonary bypass has a favorable influence on patients with chronic obstructive pulmonary disease, who have high risk in open-heart surgery.

Keywords: Blood Gas Analysis, Blood Pressure, Cardiopulmonary Bypass - methods, Hemodynamic Processes, Leukocyte Count, Postoperative Care - methods, Postoperative Care - statistics & numerical data, Postoperative Care - utilization, Prospective Studies, Pulmonary Circulation - physiology, Pulmonary Disease, Chronic Obstructive - blood, Pulmonary Disease, Chronic Obstructive - surgery, Pulsatile Flow, Vascular Resistance, Blood Gas Analysis, Blood Pressure, Cardiopulmonary Bypass - methods, Hemodynamics, Leukocyte Count, Postoperative Care - utilization, Prospective Studies, Pulmonary Circulation - physiology, Pulmonary Disease, Chronic Obstructive - surgery, Pulsatile Flow, Vascular Resistance

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750