Pulsatile cardiopulmonary bypass. A review.

Pulsatile perfusion during cardiopulmonary bypass has recently been introduced into clinical practice. In this paper the experimental basis for the superiority of pulsatile perfusion is reviewed. In particular, the haemodynamic and metabolic superiority of pulsatile perfusion is outlined. In addition, more practical aspects of pulsatile pump systems are discussed. The mechanism of pulsatile flow generation and the type of arterial wave form produced, are considered in relation to the pulsatile systems presently available for clinical use. Studies on haemolysis during pulsatile perfusion are also discussed and the overall suitability of current systems for routine clinical use is assessed. The author concludes that presently available pulsatile pump systems may confidently be incorporated into routine open-heart surgical practice without compromising the reliability or the safety of the perfusion credit.