In this study, controllability, safety, blood cell depletion, and hemolysis of a pulsatile roller pump in high-risk patients was evaluated. Sarns 8000 roller pump (Sarns, Terumo CVS, Ann Arbor, MI, USA) with a pulsatile control module was used as arterial pump in a clinical setting. Forty patients undergoing elective open heart surgery with high-risk either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be operated on using pulsatile perfusion or non-pulsatile perfusion. Blood samples were withdrawn at induction of anesthesia, at the time of aortic clamping and de-clamping and at 1 hour and 24 hours following cessation of the bypass. Hematocrit and plasma free hemoglobin values were measured. We observed that the pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study is safe in high-risk patients undergoing cardiopulmonary bypass. We did not face any emboli, hemolysis, or technical problems. Pulsatile roller pump perfusion with Sams 8000 heart-lung machine is a simple and reliable technique and can be easily applied during open heart surgery.