Comparative Effects of Pulsatile and Nonpulsatile Flow on Plasma Fibrinolytic Balance in Pediatric Patients Undergoing Cardiopulmonary Bypass

Agirbasli M. A. , SONG J., LEI F., WANG S., KUNSELMAN A. R. , CLARK J. B. , ...More

ARTIFICIAL ORGANS, vol.38, no.1, pp.28-33, 2014 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 38 Issue: 1
  • Publication Date: 2014
  • Doi Number: 10.1111/aor.12182
  • Title of Journal : ARTIFICIAL ORGANS
  • Page Numbers: pp.28-33
  • Keywords: Fibrinolytic balance, Plasminogen activator inhibitor-1, Tissue plasminogen activator, Pulsatile flow, Cardiopulmonary bypass, PLASMINOGEN-ACTIVATOR INHIBITOR-1, CENTRAL-NERVOUS-SYSTEM, HEART-SURGERY, BRAIN, PERFUSION, OUTCOMES, BIOMARKERS, PROTECTION, CHILDREN, INFANTS


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.