Comparative effects of pulsatile and nonpulsatile flow on plasma fibrinolytic balance in pediatric patients undergoing cardiopulmonary bypass.
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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 (1.5mL) were collected (i) prior to incision, (ii) 1h after CPB, and (iii) 24h after CPB. PAI-1 and tPA levels were measured at each time point. PAI-1 and tPA levels were significantly increased at 1h after CPB, followed by a decrease at 24h. Nonpulsatile but not pulsatile CPB lowered PAI-1:tPA ratio significantly at 24h (median PAI-1:tPA ratio 4.630.83:1.980.48, P=0.03, for the nonpulsatile group and 4.500.92:3.561.28, 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.
