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Some surgeons prefer pulsatile to nonpulsatile flow in extracorporeal circu lation. They believe that pulsatile flow is more physiologic, provides better tis sue perfusion, gives less damage to the blood elements and plasma proteins and causes less complement activation when compared with nonpulsatile perfusion. In order to compare the pulsatile with nonpulsatile flow during extracorporeal circulation, the authors studied two different groups of patients, each consist ing of 20 coronary bypass candidates. The patients in the two groups had almost the same properties and were operated on under the same circumstances. In the first group extracorporeal circulation was established with a nonpulsatile roller pump. In the other group a pulsatile assist device was integrated into the arterial line of the extracorporeal circuit with the roller pump. Extracorporeal circula tion was maintained with pulsatile flow obtained by an intraaortic balloon pump pneumatic console. The patients in the two groups were selected to be similar in terms of sex, age, preoperative clinical characteristics and hemodynamic and angiographic findings. Thirty-two operative and early and late postoperative parameters were compared in these two groups. In conclusion, no superiority of pulsatile flow established with the pulsatile assist device over nonpulsatile flow during extracorporeal circulation was seen.

Of 632 valvular heart disease patients 187 were operated on because of multivalvular rheumatic lesions. The operative mortality was 10.1% and late mortality 4.9%. Left ventricular dysfunction was the common cause in the early operative period. Prosthetic valve endocarditis and thromboembolism were the other common causes of mortality, 5.9% and 6.4% respectively. NYHA Class III-IV, pulmonary hypertension, ejection fraction less than 40%, aortic stenosis and elevated left ventricular end diastolic pressure were significant predictors of poor-prognosis. Tricuspid regurgitation due to right heart decompensation is also another grave sign. The type of the prosthetic valve or additional annuloplasties to double valve replacement did not influence the outcome. Optimal timing of the operation is essential. Urgent operations should always be avoided if possible. Earlier surgical intervention, improved perioperative myocardial preservation, and alternate support methods, and improved surgical techniques may lower the operative mortality and morbidity.