Background: The clinical benefits of pulsatile perfusion during cardiopulmonary bypass (CPB) remain a subject of debate. This study aimed to compare clinical outcomes between pulsatile and non-pulsatile perfusion during CPB in patients undergoing elective cardiac surgery. 

Materials and methods: Eighty patients undergoing elective atrial septal defect (ASD) closure or mitral valve replacement (MVR) between July 2019 and July 2020 were randomized to two groups: pulsatile perfusion (PP) group and non-pulsatile perfusion (NP) group. All surgeries were performed by a single surgical team. In the PP group, pulsatile flow was maintained at 60–80 per minute for adults and 80–120 per minute for pediatric patients, pulse pressure was maintained higher than 15 mm Hg, while all other intraoperative management and perioperative protocols were kept consistent between groups. The two groups were compared in terms of length of ICU stay, hospital stay, renal function test, liver function test, and complications. 

Results: 77 patients with a mean age of 33.8 ± 15.9 were included in the final analysis. The groups were similar in demographics, clinical and intra-operative variables, except body surface area and baseline creatinine, which were higher in the pulsatile group. Length of ICU stay, hospital stay, liver function tests, renal function tests, and complications were similar across both groups, except for higher urea (p-value 0.049) in the pulsatile group. 

Conclusions: This study did not demonstrate significant differences in clinical outcomes between pulsatile and non-pulsatile flow during CPB in elective cardiac surgery. Routine use of pulsatile flow cannot be recommended based on current findings. The study was limited by its restriction to patients undergoing ASD closure or MVR surgery and the dominance of younger patients without major comorbidities.