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Blood, urine, and bone marrow will be collected to analyze biomarkers of acute kidney injury risk. Sublingual microscopy will be used to collect images in the mouth. This is to study the following aims: Aim 1: Determine the effect of pulsatility during CPB on endothelial function. We will compare the change in endothelial function between patients receiving non-pulsatile or pulsatile flow during CPB using flow mediated dilation of the brachial artery (FMDBA). We expect that the pulsatile CPB will have better post-operative endothelial function. In addition to FMDBA, we will measure secondary endothelial function endpoints including endothelial activation, microcirculatory blood flow, and glycocalyx shedding. We will also determine the transcriptomic response of primary endothelial cells to CPB with single cell RNAseq in a subset of patients. Aim 2: Determine the effect of pulsatile CPB on renal blood flow after cardiac surgery. We will compare the change in renal blood flow determined by pulse wave Doppler ultrasonography between patients receiving non-pulsatile or pulsatile CPB. We expect that the pulsatile CPB group will have greater post-operative renal blood flow and lower renal artery resistance measured by pulse wave Doppler.

Age 50 to 80 Able to provide informed consent Scheduled for elective cardiac surgery with cardiopulmonary bypass Age 50 to 80 Able to provide informed consent Scheduled for elective cardiac surgery with cardiopulmonary bypass Those excluded are as follows: Patients undergoing emergency procedures Diagnosed with sepsis Experiencing delirium Experiencing hemodynamic instability (heart rate > 100 and systolic blood pressure < 90) Patients with a mechanical circulatory support device Requiring vasoactive medications before surgery Patients with a reduced left ventricular ejection fraction (less than 50%) Patients with a contraindication to transesophageal echocardiography