Abstract
Myocardial protection during cardiopulmonary bypass (CPB) can be achieved using cardioplegic solutions. Although, acute kidney injury (AKI) is a common complication following CPB, the effects of cardioplegic solutions on AKI have rarely been investigated. Within this study, the effects of the cardioplegic solutions histidine-tryptophan-ketoglutarate (HTK; Custodiol) and HTK-N (Custodiol-N) on AKI in a large animal model were compared. Therefore, Landrace pigs underwent median sternotomy, CPB at 34°C, 90minutes of cardiac arrest and 120minutes of reperfusion. Animals were randomized for single-shot cardioplegia with either HTK (n=10) or HTK-N (n=10). Renal biopsies and sera were analyzed to determine AKI biomarkers and apoptosis. Compared to HTK, HTK-N induced a decreased extent of proximal tubule swelling (48.3±1.6µm vs 52.3±1.1µm, P=.05) and decreased cytochrome c release (0.26±0.04 vs 0.46±0.08, P=.04) without reaching statistical significance due to Bonferroni correction. Comparing baseline and postreperfusion levels, the hemoglobin (Hb) and blood calcium levels were lower in HTK-N (Hbbaseline : 6.0±0.6mmol/L, Hbreperfusion : 6.2±0.7mmol/L, P=.12; Ca2+baseline : 1.36±0.05mmol/L, Ca2+reperfusion : 1.28±0.05mmol/L, P=.16) compared to the HTK group (Hbbaseline : 5.9±0.4mmol/L, Hbreperfusion : 4.7±0.8mmol/L, P<.01; Ca2+baseline : 1.34±0.07mmol/L, Ca2+reperfusion : 1.24±0.06mmol/L, P<.01). The present study showed that HTK-N could positively affect the kidney during CPB. Hb and calcium levels were stabilized. A statistical trend was found showing that AKI-related proximal tubule swelling and cytochrome c release were diminished.
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