The Journal of Thoracic and Cardiovascular Surgery
Congenital: Perioperative Management: Basic ScienceExogenous nitric oxide delivery protects against cardiopulmonary bypass–associated acute kidney injury: Histologic and serologic evidence from an ovine model
Graphical Abstract
Section snippets
Materials and Methods
Study approval was obtained from the Cincinnati Children's Hospital Institutional Animal Care and Use Committee (protocol #2020-0076, approved March 17, 2021). All animals received humane care in compliance with the Principles of Laboratory Animal Care formulated by the National Society for Medical Research and the Guide for Care and Use of Laboratory Animals prepared by the National Academy of Science and published by the National Institutes of Health.
Intraoperative and Postoperative Characteristics
A total of 11 (n = 6 NO-treated, n = 5 control) animals were included in the study (Table 1). Weight (NO treated: mean 22 ± 3.3 kg, control: mean 23 ± 6.1 kg, P = .643) and age (NO treated: mean 4.8 ± 2.9 mo., control: mean 5.5 ± 2.1 mo., P = .645) at time of surgery were comparable between groups. As shown in Table 2, CPB times were equivalent between groups, as were the total volumes of intraoperative fluid administration and urine output (all P > .50). Average intraoperative bladder
Discussion
In a survival ovine model of CPB-associated AKI, exogenous NO infused through the bypass circuit intraoperatively appeared efficacious in decreasing the development of postoperative severe kidney injury, as evidenced by attenuation of certain postoperative biomarkers associated with AKI and preservation of renal tubular structure (Figure 5). The first notable implication of the study is the efficacy of NO in a cardiac surgical animal model, which allowed for the controlled management and
Conclusions
In the present ovine model of CPB-associated AKI, exogenous NO infused through the oxygenator provided biomarker and histologic evidence of protection against postoperative AKI. The current study mirrors the results of clinical trials, which have shown NO to attenuate postoperative AKI in adult patients undergoing cardiac surgery, and provides several important insights into the serologic and histologic effects of NO in AKI prevention. The results add to the literature supporting the use of
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Commentary: Encouraging findings for the renal-protective effect of nitric oxide administration during cardiopulmonary bypass
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Institutional Review Board Approval: #2020-0076; date of approval: March 17, 2021.