Influence of different flow modi during extracorporeal circulation on endothelial-derived vasoactive substances.

Influences of shear stress on endothelin (ET) as well as prostacyclin (PGF) levels are common findings in different experimental settings. Thus, plasma levels of both substances seem to be a good tool to verify if different flow modi can be produced in blood vessels by generating pulsatile flow with a roller pump. In the present study, 20 patients scheduled for elective aortocoronary bypass operation were divided into two groups at random. One group was perfused with nonpulsatile (CON-group) and the other with pulsatile flow (PULS-group) during extracorporeal circulation. ET and PGF plasma levels were monitored perioperatively together with parameters of renal function and haemodynamic data. ET values were only slightly elevated at the end of extracorporeal circulation (mean baseline value; CON 3.1 pg/ml and PULS 3.2 pg/ml; mean maximal values at the end of cardiopulmonary bypass (CPB) 4.0 pg/ml and 3.9 pg/ml respectively). Prostacylin values (median baseline values: CON 56.7 pg/ml and PULS 57.1 pg/ml) peaked at the end of operation (median CON 117.8 pg/ml and PULS 137.5 pg/ml respectively) with a subsequent small decrease. No differences between the groups could be observed at any time point with respect to vasoactive substances, urine output (CON 6.5 ml/min and PULS 6.2 ml/min) or haemodynamics during CPB. This confirms studies emphasizing that no effective microvascular pulsatile flow is generated by conventional pulsatile flow-generating devices. In the present study, normothermia and a constant flow rate were maintained during CPB. Aortic cannulae (body-surface-related not maximal large diameters) were inserted. Altering these procedures may have led to more pronounced differences between the groups. All patients had an uneventful course after the operation. Similar to other reports, the present study was not able to demonstrate any benefit of pulsatile perfusion during extracorporeal circulation.

RCT Entities:   Population Interventions Outcomes