EFFECT OF PERIOPERATIVE NITRIC OXIDE DELIVERY ON NITROSYL STRESS AND LOCAL INFLAMMATION-MEDIATED TUBULAR KIDNEY INJURY DURING HEMIARCH SURGERY

Highlights The organoprotective effect of nitric oxide during cardiac surgery, including reconstructive interventions on the aorta, is widely studied, however, its use may be limited due to the likely development of side effects, including kidney damage. This paper presents data on the study of the possible negative effects of nitric oxide on the kidneys in patients undergoing Hemiarch surgery. Abstract Aim. To evaluate the effect of perioperative nitric oxide delivery on the severity of nitrosyl stress and renal tubular injury mediated by local inflammation activation during Hemiarch surgery under conditions of cardiopulmonary bypass and hypothermic circulatory arrest. Methods. The work presents the data of a single-center, single-blind, prospective, randomized controlled trial. The study included 80 patients over 18 years of age who underwent Hemiarch surgeries under artificial circulation and hypothermic circulatory arrest for non-syndromic ascending aortic aneurysms in the period 2020–2023. All patients were randomized into two groups in a 1:1 ratio: the NO group (main group), which received perioperative delivery of nitric oxide at a concentration of 80 ppm, and the standard perioperative support group (control group, NO delivery was not performed). To assess the severity of NO-mediated nitrosyl stress, the concentration of nitrotyrosine in the blood serum was measured. Blood was sampled immediately after placement of the central venous catheter and 4 hours after the end of the surgery. To assess the severity of renal tubular injury mediated by local inflammation activation, the concentration of IL-18 in urine was determined. Urine was collected after bladder catheterization and 4 hours after the end of surgery. Results. The concentration of nitrotyrosine 4 hours after surgery was 10.67 [8.99; 12.50] ng/ml in the NO group and 6.74 [5.89; 10.50] ng/ml in the no-NO group (p = 0.13). The concentration of IL-18 in urine 4 hours after surgery was 5.01 [4.06; 5.98] ng/ml in the NO group and 5.82 [3.60; 29.40] ng/ml in the no-NO group (p = 0.50). Conclusion. Perioperative delivery of 80 ppm NO during Hemiarch surgery under CPB and hypothermic circulatory arrest does not induce NO-mediated nitrosyl stress and does not affect renal tubular injury mediated by local inflammatory activation.