# Intestinal Tissue Damage Reduction After Distal Perfusion for Aortic Arch Surgery in a Neonatal Porcine Model

## TL;DR

Adding distal perfusion during aortic arch surgery in neonatal pigs reduces intestinal damage and improves tissue protection.

## Contribution

The study demonstrates that SACP with distal perfusion reduces intestinal damage and activates protective mechanisms in neonatal pigs.

## Key findings

- SACP + DP showed less intestinal tissue damage and better structural integrity compared to SACP.
- SACP + DP upregulated cytoprotective molecules like DJ-1 and Nrf2 in the small intestine.
- E-cadherin expression was lower in the colon of the SACP + DP group, indicating altered epithelial barrier function.

## Abstract

Background: Aortic arch reconstruction in neonates is often challenging, owning its surgical complexity and postoperative complication risk. To assess intestinal damage, we compared selective anterograde cerebral perfusion (SACP) and SACP with additional distal perfusion (SACP + DP) used in aortic arch surgery in a neonatal piglet model. Methods: Piglets underwent cardiac arrest for 60 min with SACP (n = 9) or SACP + DP (n = 9), followed by a 120 min recovery. Hemodynamic parameters, blood gases and electrolytes were monitored. Biopsies of the small intestine and colon were analyzed for histopathological changes, intestinal barrier function, and oxidative stress. Results: Hemodynamic measurements and electrolyte concentrations were comparable between SACP and SACP + DP (p > 0.05), except for potassium levels during cardiac arrest (p = 0.03). Blood lactate levels (p < 0.01) were elevated and pH values (p < 0.01) were reduced in the SACP group during cardiac arrest. Morphometric analysis of the intestinal tissue revealed longer crypts (p = 0.02) and a thicker mucosal layer (p = 0.05) of colonic structures in the SACP group. Compared to SACP, the mRNA expression of cytoprotective Parkinson’s disease protein DJ-1 (p = 0.02) and hypoxia-inducible nuclear factor erythroid 2-related factor 2 (p = 0.04) were higher in the small intestine of the SACP + DP group. The marker of epithelial barrier function, E-cadherin, showed lower mRNA expression in the colon of the SACP + DP group (p = 0.02). Conclusions: Our study results showed that SACP + DP revealed less intestinal tissue damage and loss of structural integrity, as well as an upregulation of cytoprotective molecules and anti-oxidative stress mechanisms. Therefore, SACP + DP is a reliable procedure in our model for aortic arch surgery that can contribute to better postoperative outcomes by reducing intestinal damage.