Distal perfusion during complex aortic arch procedure reduces kidney injury in newborn piglets at moderate...

Complex aortic arch procedures in newborns require the most optimal perfusion strategy to prevent acute kidney injury and its consequences from developing. We performed a randomized comparison of the selective anterograde cerebral perfusion (SACP) and SACP with additional distal perfusion (SACP+DP) with moderate hypothermia in a neonate piglet model to generate better insights into renal tissue-specific injury due to the different perfusion strategies in newborns.

Newborn piglets (2.5-10 kg) were randomized to undergo cross-clamp for 60 min with either SACP (n = 9) or SACP+DP (n = 9) followed by 120 min of recovery. Renal biopsies were analysed for histomorphological changes and the induction of hypoxia-related factors. Kidney injury markers were analysed in piglet serum.

Histomorphological analyses of renal biopsies after 120-min recovery showed comparable glomeruli area (P = 0.06), glomerular capsule space length (P = 0.25), proximal tubules cell height (P = 0.09) and diameters of proximal tubules (P = 0.23) between SACP and SACP+DP. hypoxia-inducible factor 1α nuclear translocation, a marker for oxidative stress, was higher in the glomeruli (P < 0.01) and proximal tubules (P = 0.05) in the SACP group compared to the SACP+DP group. Serum concentrations of neutrophil gelatinase-associated lipocalin were higher in the SACP group (100.3 ± 40.8 ng/ml) compared to the SACP+DP group (67.4 ± 19.3 ng/ml, P = 0.03).

Our neonate piglet study demonstrated higher oxidative stress in vulnerable nephron structures in renal tissue and higher serum neutrophil gelatinase-associated lipocalin concentrations with SACP compared to SACP+DP indicating that SACP+DP is more suitable to reduce renal insult induced by complex aortic arch procedures.