Pulsatil Akýmlý Kardiyopulmoner Bypassýn Pediyatrik ve Yetiþkin Açýk-Kalp Hastalarýnda Kullanma Prensipleri PRINCIPLES AND PRACTICES OF PULSATILE PERFUSION IN PEDIATRIC AND ADULT OPEN-HEART SURGERY

Although the benefits of pulsatile perfusion during pediatric and adult cardiopulmonary bypass (CPB) procedures are clearly documented in the literature, the controversy still continues [1-20]. The following are the three main reasons for this long-standing controversy. 1) Lack of precise quantification of arterial pressure and pump flow waveforms: To date, we do not have a common or universal definition of pulsatile flow [20-22]. Without a definition or a precise quantification, it is impossible to make direct and meaningful comparisons of different perfusion modes [1,2]. 2) Poor choice of pulsatile pumps and disposables: Each component of the circuit must be selected based on its previous performance in different perfusion modes because not only the pulsatile pump, but also the membrane oxygenator and the aortic cannula each have a direct impact on the quality of pulsatility [23-25]. Unfortunately, most of the investigators today select circuit components without any scientific justification. 3) Limitations of experimental designs: Several investigators in the past used pulsatile flow for only a few minutes, then expected to see significant improvement in cerebral function [26,27]. In order to see the benefits of pulsatile flow, it should be used continuously during CPB. In addition, patient selection is another important factor for meaningful comparisons between Pulsatil Akýmlý Kardiyopulmoner Bypassýn Pediyatrik ve Yetiþkin Acýk-Kalp Hastalarýnda Kullanma Prensipleri