Pulsatile versus nonpulsatile perfusion revisited.

摘要

In their systematic review, Alghamdi and Latter have undertaken a survey of all published clinical trials and clinical reports examining pulsatile versus nonpulsatile perfusion in adult patients undergoing elective coronary artery bypass surgery. Unfortunately, of the more than 40 separate reports that were cataloged and analyzed by these authors, only eight met the inclusion criteria of this review, and only four of these were randomized controlled studies. Of the four cohort studies, all but one were rated as "poor." Similarly, only one of the four controlled trials was rated as being of "fair" quality. That study, despite the inclusion of more than 300 patients, prospective stratification by surgeon, employment of a blinded outcomes assessment, and a rigorous randomization process, apparently failed to score more highly due to "insufficient details having been provided regarding maintenance of comparability and avoidance of cointerventions." Interestingly, however, it did demonstrate a significant decrease in both mortality and myocardial infarction (Ml) associated with pulsatile perfusion. The other three randomized trials were all rated as "poor" and did not detect any outcome benefit for pulsatility.