On-pump Beating Coronary Artery Bypass Grafting by Ventricular Assist
- Conditions
- Coronary Artery Bypass
- Interventions
- Device: left ventricular assistProcedure: Biventricular assist
- Registration Number
- NCT02731794
- Lead Sponsor
- Henan Institute of Cardiovascular Epidemiology
- Brief Summary
The investigators designed the randomized prospective study to evaluate the differences of inflammatory response and clinical outcome after on-pump beating coronary artery bypass grafting undergoing left ventricular assist versus biventricular assist in patients with severe left ventricle dysfunction.
- Detailed Description
Off-pump coronary artery bypass grafting (CABG) tends to have a lower incidence of postoperative complications and remarkable advantages in terms of hospital stay. However, some drawbacks include higher rates of incomplete revascularization and the hemodynamic deterioration during manipulation of the heart, more occurring in the cases of posterolateral anatomical constraints and cardiac dysfunction. It leads to urgent conversion to extracorporeal circulation (ECC) and increases the mortality. Although conventional ECC with cardioplegia arrest provides bloodless immovable field, intense systemic inflammatory response may contribute to hemodynamic unstability especially in patients already with severe cardiac dysfunction.
On-pump beating CABG, as a more comprehensive approach, not only facilitates stable hemodynamics and complete revascularization, but also supports myocardial lymphatic flow balance and decreases interstitial myocardial edema in the beating state. Especially in the high-risk patients,some findings suggested that off-pump CABG should be converted to on-pump beating CABG without hesitation, avoiding hemodynamic collapse and even catastrophic outcomes. Some investigators intentionally planned on-pump beating CABG aiming to some patients with severe left ventricle dysfunction. Furthermore, on-pump beating CABG with ECC assistance in a high-risk subgroup is also an acceptable trade-off between conventional cardioplegia and off-pump operations.
The above-mentioned ECC results about on-pump, beating-heart CABG pay much attention to the biventricular assist (BiVA). Nonetheless, much evidence also reveals that BiVA triggers an intense inflammatory response due to extracorporeal membrane lung and circuit line. Comparatively speaking, single left ventricular assist (LVA), with shorter circuit line, less priming volume and free of extracorporeal membrane lung, theoretically should reduce the inflammatory response and relative complications. As a result, aiming to the high-risk patients with severe left ventricle dysfunction, who need ECC assistance (BiVA or LVA), the investigators designed the randomized prospective study to evaluate: 1) the differences in myocardial injury as expressed by cardiac Troponin I(cTnI) and in inflammatory response by C-reactive protein (CRP), 2) the differences in the early postoperative outcomes including graft number, incidence of atrial fibrillation, in-hospital mortality and ICU stay.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 70
- patients with severe left ventricle dysfunction with an ejection fraction (EF)≤40%, being scheduled for revascularization.
- myocardial infarction within the preceding 4 weeks
- severe valve disease requiring valve replacement
- cardiac reoperations
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description LVA group left ventricular assist LVA group: left ventricular assist group. BiVA group Biventricular assist BiVA group: Biventricular assist group.
- Primary Outcome Measures
Name Time Method Changes of C-reactive protein (CRP) up tp 72 hours Serial blood samples for inflammatory response of CRP were collected at the following time points: 1: induction of anesthesia, 2: upon termination of cardiopulmonary bypass (CPB), 3: 6 hours postoperatively, 4: 24 hours postoperatively, 5: 48 hours postoperatively, 6: 72 hours postoperatively.
- Secondary Outcome Measures
Name Time Method Incidence of atrial fibrillation 10 days from ICU admission to discharge
Durations of mechanical ventilation 10 days The number for transfused packed red cells up to 10 days measured by milliliter from ICU admission to discharge
In-hospital mortality up to 10 days from ICU admission to discharge
Partial oxygen pressure/inspired oxygen fraction (P/F) up tp 10 days Cardiac Troponin I (cTnI) up to72 hours Serial blood samples for cTnI were collected at the following time points: 1: induction of anesthesia, 2: upon termination of CPB, 3: 6 hours postoperatively, 4: 24 hours postoperatively, 5: 48 hours postoperatively, 6: 72 hours postoperatively.
Trial Locations
- Locations (1)
Henan Provincial People' Hospital
🇨🇳Zhengzhou, Henan, China