Early Outcome of Total Arterial Revasclarization in IHD

• Conditions: Ischemic Heart Disease

• Registration Number: NCT03577821
• Lead Sponsor: Assiut University

Brief Summary

Complete arterial coronary artery bypass grafting (CABG) is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). The goal of coronary artery bypass operations is complete revascularization and there is an increasing interest toward complete arterial revascularization to achieve this goal because of high late failure of saphenous vein graft

Detailed Description

The availability of arterial conduit which is long enough to perform complete arterial revascularization is the limitation of the procedure and it is mandatory to adjust length of the available graft to serve the need. To overcome this problem, sequential or/ and composite grafting techniques are used and one conduit is used for more than one distal anastomoses or multiple arterial grafts are preferred. Bilateral internal mammarian arteries (IMAs), the gastroepiploic artery (GEA), inferior epigastric artery and the radial artery (RA) have been used as conduits in selected patients. However, sequential grafting using arterial grafts may not be convenient for all circumstances and sometimes surgical technique may be challenging. Besides, classical Y-graft technique of RA has the disadvantage of shortening the graft. Harvesting multiple arterial conduits is more time consuming and may result in elevated operative trauma and perioperative complications (sternal dehiscence, sternal infection, pulmonary complications, required laparatomy, prolonged ICU time and hospitalization time, etc.). Every eligible patient should receive total arterial revascularization, the cornerstone of which is BITA grafting. Patients with a body mass index (BMI) of over 35, diabetes or severe airway disease or who are undergoing radio- therapy or immunosuppression are only relatively contra- indicated for BITA use.7 If more conduits are required, the RA can be prepared at the same time as the LITA, and its harvesting is associated with favorable early outcomes Prior to harvesting, a modified Allen test is performed. If a hyperemic response to the previous ischemic hand is noticed within 5 s, the collateral ulnar circulation is adequate. Restoration of the blood circulation to the ischemic hand later than 10 s after the ulnar release excludes the RA from being used.

Duplex examination and pulse oximetry can also be used to preoperatively evaluate the RA and ulnar artery. Moreover, the RA should be avoided when cardiac catheterization has been recently pre- ceded by injuring the vessel and when the RA might be used for future fistulae in patients who are receiving or who are likely to receive dialysis\] RAs less than 2 mm in diameter are also avoided due to the possibility of vasospasm.

Finally, the extent of stenosis of the target coronary vessel may also constitute a contraindication for arterial conduit use due to competitive flow. Hence, stenoses of less than 70% in the left coronary bed and less than 90% in a dominant right coronary artery should prevent the use of an arterial graft.

Study Timeline

• Status Verified: 2018-06
• Study First Submitted: 2018-06-08
• Study Start: 2018-07-01
• Study First Submitted QC: 2018-07-03
• Last Update Submitted: 2018-07-03
• Study First Posted: 2018-07-05
• Last Update Posted: 2018-07-05
• Primary Completion: 2019-12-30
• Study Completion: 2020-02-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

All patients who will undergo total arterial revascularization either with single or multi vessel coronary artery disease are to be put in the investigator's study work.

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Exclusion Criteria

• there is no any.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
target vessel revascularization	baseline-3 months	readmission for revascularization due to graft failure

Secondary Outcome Measures

Name	Time	Method
Major cardiac events	baseline-3 months	(myocardial infarction, stroke, readmission for CHF)
Postoperative morbidity	3 months	frequency of peroperative/ postoperative complications according to registration schemes
Wound infection	3 months	Readmission for wound infection (superficial sternal wound infection, deep sternal wound infection, saphenous vein related wound infection, need for VAC therapy, need for surgical debridment, need for prolonged antibiotic therapy)
Bleeding	Early postoperative up to 1 week	surgical bleeding requiring re-exploration
Length of ICU stay	Early postoperative up to 1 week	number of days in ICU