Comparable renal effects of histidine-tryptophan-ketoglutarate and DelNido cardioplegia in a porcine model of cardiac arrest

Acute kidney injury (AKI) is a serious complication following on-pump cardiac surgery. Choosing the cardioplegic solution with the most appropriate myocardial protection and lowest grade of AKI could improve patient outcome. We compared the crystalloid histidine-tryptophan-ketoglutarate (HTK) solution and a Jonosteril®-based DelNido blood cardioplegic solution regarding AKI in a porcine model. Therefore, German landrace pigs (50–60kg) underwent median sternotomy, cardiopulmonary bypass at 34 °C and 90 min of cardiac arrest. Animals were randomized to single-shot cardioplegia of HTK (n = 9) or DelNido (n = 9) cardioplegic solution followed by 120 min of reperfusion. This study demonstrated that DelNido cardioplegia induced less hemoglobin (p p p = 0.38), neutrophil gelatinase-associated lipocalin (p = 0.34), and cystatin C (p = 0.46), which could not detect any differences between the groups. This large animal study demonstrated superiority of the DelNido solution regarding hemoglobin and blood electrolyte concentrations, but comparability of the HTK and DelNido blood cardioplegic solution regarding AKI for surgical interventions requiring cardiac arrest of 90 min. Patients with a higher risk for adverse events, due to either complex, prolonged surgery or a multitude of comorbidities, could especially benefit from the more physiological arrest conditions with DelNido cardioplegia.急性肾损伤（acute kidney injury, AKI）是体外循环心脏手术后的严重并发症。选择具备最优心肌保护效果且致急性肾损伤风险最低的心脏停搏液，可改善患者预后。 本研究在猪模型中对比了晶体型组氨酸-色氨酸-酮戊二酸（histidine-tryptophan-ketoglutarate, HTK）停搏液与基于Jonosteril®的DelNido含血心脏停搏液对急性肾损伤的影响。 实验选用体重50~60kg的德国长白猪，实施正中胸骨切开术，建立34℃体外循环模型，并维持90分钟心脏停搏状态。将实验动物随机分为两组，分别接受单次HTK（n=9）或DelNido（n=9）心脏停搏液灌注，后续维持120分钟再灌注期。 本研究结果显示，DelNido心脏停搏液可降低血红蛋白（p = 0.38）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin）及胱抑素C（p = 0.46）水平，但两组间上述指标均未检测到显著统计学差异。 这项大型动物实验证实，在血红蛋白及血液电解质浓度方面，DelNido停搏液更具优势；而针对需维持90分钟心脏停搏的外科手术，在急性肾损伤防控效果上，HTK与DelNido含血心脏停搏液具有可比性。 对于因手术复杂冗长或合并多种基础疾病而具有较高不良事件风险的患者，采用DelNido心脏停搏液所营造的更符合生理状态的心脏停搏条件，或将使其尤其获益。