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Comparative Effects of Pulsatile and Nonpulsatile Flow on Plasma Fibrinolytic Balance in Pediatric Patients Undergoing Cardiopulmonary Bypass
Author(s) -
Aĝirbaşli Mehmet A.,
Song Jianxun,
Lei Fengyang,
Wang Shigang,
Kunselman Allen R.,
Clark Joseph B.,
Myers John L.,
Ündar Akif
Publication year - 2014
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12182
Subject(s) - cardiopulmonary bypass , pulsatile flow , plasminogen activator , tissue plasminogen activator , medicine , plasminogen activator inhibitor 1 , perfusion , fibrinolysis , cardiology , anesthesia
Abstract In the brain, the components of the fibrinolytic system, tissue plasminogen activator ( tPA ) and its endogenous inhibitor plasminogen activator inhibitor‐1 ( PAI ‐1), regulate various neurophysiological and pathological responses. Fibrinolytic balance depends on PAI ‐1 and tPA concentrations. The objective of this study is to compare the effects of pulsatile and nonpulsatile perfusion on fibrinolytic balance in children undergoing pediatric cardiopulmonary bypass ( CPB ). Plasma PAI ‐1 antigen and tPA antigen were measured in 40 children ( n = 20 pulsatile and n = 20 nonpulsatile group). Plasma samples (1.5 mL) were collected (i) prior to incision, (ii) 1 h after CPB , and (iii) 24 h after CPB . PAI ‐1 and tPA levels were measured at each time point. PAI ‐1 and tPA levels were significantly increased at 1 h after CPB , followed by a decrease at 24 h. Nonpulsatile but not pulsatile CPB lowered PAI ‐1 : tPA ratio significantly at 24 h (median PAI ‐1 : tPA ratio 4.63 ± 0.83:1.98 ± 0.48, P = 0.03, for the nonpulsatile group and 4.50 ± 0.92:3.56 ± 1.28, P = 0.2, for the pulsatile group). These results suggest that pulsatile flow maintains endogenous fibrinolytic balance after pediatric cardiopulmonary bypass. Further studies are needed to define the clinical significance of these differences.