Key result
Perioperative nitric oxide administration at 80 ppm reduced the incidence of acute kidney injury compared to standard management (25% vs 50%; OR 0.26; 95% CI 0.10-0.69; P=0.036).
Why the study?
The study was conducted to evaluate whether perioperative nitric oxide administration reduces the incidence of acute kidney injury during hemiarch surgery for nonsyndromic ascending aortic aneurysms under cardiopulmonary bypass and hypothermic circulatory arrest.
Does perioperative nitric oxide administration reduce the incidence of acute kidney injury in adult patients undergoing hemiarch aortic surgery with hypothermic circulatory arrest?
RCT (n=80)
Single-blind
1:1
Does perioperative nitric oxide administration reduce the incidence of acute kidney injury in adult patients undergoing hemiarch aortic surgery with hypothermic circulatory arrest?
Odds Ratio: 0.26 (95% CI 0.1–0.69)
Absolute Event Rate: 25% vs 50%
p-value: p=0.036
Perioperative nitric oxide administration at 80 ppm significantly reduces the incidence of acute kidney injury and shortens ICU stay in patients undergoing hemiarch aortic surgery with hypothermic circulatory arrest.
NO halves AKI incidence in hemiarch surgery with HCA; extends prior cardiac surgery RCTs to this high-risk aortic population.
Aim. To evaluate the efficacy of perioperative nitric oxide (NO) administration in reducing the incidence of acute kidney injury (AKI) during hemiarch surgery for nonsyndromic ascending aortic aneurysms under cardiopulmonary bypass and hypothermic circulatory arrest (HCA). Materials and Methods. A single-blind, prospective, randomized, controlled study included 80 patients older than 18 years who underwent hemiarch aortic surgery with HCA for nonsyndromic ascending aortic aneurysms between 2020 and 2023. Patients were randomized (1:1) into two groups: the NO group (who received perioperative NO at 80 ppm) and the control group (who received standard perioperative management without NO administration). The primary endpoint was the incidence of AKI according to KDIGO criteria. Secondary endpoints included biomarker levels of subclinical renal injury and clinical outcomes. Results. Postoperatively, the incidence of AKI was 25% in the NO group compared to 50% in the control group (OR = 0.26; 95% CI: 0.10-0.69; P = 0.036). Patients in the NO group had significantly lower levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL, P=0.03) and cystatin C (P<0.001) 4 hours after surgery. In addition, the length of stay in the intensive care unit (ICU) was significantly shorter in the NO group (P = 0.03) compared to the control group. Conclusion. Perioperative NO therapy at 80 ppm during hemiarch aortic surgery with HCA reduces the incidence of acute kidney injury, lowers the levels of kidney injury biomarkers (uNGAL and cystatin C), and shortens the ICU stay.
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Boĭko et al. (2025) conducted an RCT in Nonsyndromic ascending aortic aneurysms (n=80). Nitric oxide vs. Standard perioperative management without nitric oxide was evaluated on Incidence of acute kidney injury (AKI) according to KDIGO criteria (OR 0.26, 95% CI 0.10-0.69, p=0.036). Perioperative nitric oxide administration at 80 ppm reduced the incidence of acute kidney injury compared to standard management (25% vs 50%; OR 0.26; 95% CI 0.10-0.69; P=0.036).
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