{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T16:02:26Z","timestamp":1793203346497,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drawing on more than 30 years of valuable expertise in in-vitro, in-vivo, and clinical trials, we report the key findings of our institutional research on pulsatile cardiopulmonary bypass (CPB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A detailed search was performed in the National Institutes of Health National Library of Medicine, focusing on the PubMed database. This search combined key terms such as \u201cPulsatile flow,\u201d \u201cCardiopulmonary Bypass,\u201d \u201cUndar A,\u201d \u201cVital Organ Injury,\u201d \u201cClinical outcomes,\u201d \u201cPediatrics,\u201d and \u201cNeonates and infants\u201d to find relevant peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A comprehensive review article was crafted by analyzing 88 peer-reviewed studies published between 1996 and 2025. This research provided substantial scientific evidence on optimizing neonatal and pediatric cardiopulmonary bypass (CPB) circuitry, focusing not only on pump performance but also on selecting appropriate oxygenators and arterial cannulas for effective pulsatile flow. While significant benefits regarding cerebral hemodynamics were observed in neonatal piglet models using pulsatile flow in conjunction with deep hypothermic circulatory arrest, the results from randomized clinical trials and retrospective studies raised questions regarding its efficacy. Despite some promising indications of improved Apolipoprotein E and plasminogen activator inhibitor-1\/tissue plasminogen activator ratios, a rigorous randomized clinical trial involving 159 patients, along with a comprehensive retrospective study of 284 patients at Penn State Health Children's Hospital, demonstrated no significant clinical advantage of pulsatile flow compared with nonpulsatile flow. Importantly, while pulsatile flow did not provide a measurable benefit, it also did not result in any adverse outcomes in our clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The existing evidence clearly indicates that pulsatile CPB does not provide significant short-term or long-term benefits for pediatric patients undergoing congenital heart surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501351251412887","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:04:16Z","timestamp":1770228256000},"page":"655-665","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Three Decades of Evidence on Pulsatile Cardiopulmonary Bypass in Pediatrics: No Significant Clinical Benefit"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3334-2886","authenticated-orcid":false,"given":"Akif","family":"\u00dcndar","sequence":"first","affiliation":[{"name":"Penn State College of Medicine"},{"name":"Penn State College of Medicine"},{"name":"Penn State College of Medicine"},{"name":"Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc J.","family":"Lussier","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0141-1132","authenticated-orcid":false,"given":"Srihari","family":"Rajesh","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevserg\u00fcl","family":"Dayi","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"\u00dcndar A. Design and performance of physiologic pulsatile flow cardiopulmonary bypass systems for neonates and infants. PhD Dissertation The University of Texas at Austin Biomedical Engineering Austin TX 1996 p. 1\u2013343."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)00913-3"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2001.114931"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mat.0000178215.34588.98"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.02.053"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2022.02.053"},{"key":"e_1_3_4_8_2","first-page":"786","article-title":"The effects of pulsatile versus non-pulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous emboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery","volume":"16","author":"Patel K","year":"2023","unstructured":"Patel K, Dan Y, Kunselman AR, Clark JB, Myers JL, \u00dcndar A. The effects of pulsatile versus non-pulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous emboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery. 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