Effects of Remote Ischemic PreConditioning in Off-pump Versus On-pump Coronary Artery Bypass Grafting(RIPCON)

NCT ID: NCT01608984

Last Updated: 2013-07-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE1

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-05-31

Study Completion Date

2015-12-31

Brief Summary

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Purpose Remote ischemic preconditioning (RIPC) with transient upper limb ischemia reduces myocardial injury in patients undergoing On-pump coronary artery bypass (CABG) surgery with cross-clamp fibrillation or blood cardioplegia for myocardial protection. The molecular mechanisms leading to these effects are yet not fully understood. The purpose of the present study is to validate previous studies and gather further evidence for RIPC during CABG with blood cardioplegia, furthermore to determine, whether or not RIPC is still operative during Off-pump coronary artery bypass surgery (OPCAB), finally to elucidate intra-cellular mechanisms involved in myocardial protection by RIPC and their possible systemic mediators.

Detailed Description

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Remote ischemic preconditioning (RIPC) protocol before CABG (study arm A) or OPCAB (study arm B) consists of 3 cycles of 5 minutes left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 minutes of reperfusion after induction of anesthesia before coronary artery bypass surgery. For myocardial molecular analyses, left ventricular biopsies are taken before induction of cardioplegic cardiac arrest (A) or first coronary incision (B), and 5 to 10 minutes after aortic unclamping during reperfusion of the myocardium (A) or 5 to 10 minutes after the completion of the last anastomosis (B). Blood samples are taken prior to RIPC and during the first three postoperative days.

Conditions

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Myocardial Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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RIPC-CABG

Remote ischemic preconditioning (RIPC) protocol before coronary artery bypass surgery with blood cardioplegia for cardiac arrest (CABG) consists of 3 cycles of 5 minutes left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 minutes of reperfusion after induction of anesthesia before coronary artery bypass surgery. For myocardial molecular analyses, left ventricular biopsies are taken before induction of cardioplegic cardiac arrest and 5 to 10 Minutes after aortic unclamping during reperfusion of the myocardium. Blood samples are taken up to 72 hours postoperatively.

Group Type ACTIVE_COMPARATOR

Remote ischemic preconditioning (RIPC)

Intervention Type PROCEDURE

3 cycles of 5 min left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 min reperfusion.

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required. In the CABG-arms, during extracorporal circulation patients receive isoflurane via a vaporizer incorporated in the extracorporeal gas supply in the same concentrations.

Control-CABG

Control group: Coronary artery bypass grafting without RIPC protocol

Group Type PLACEBO_COMPARATOR

Coronary artery bypass grafting (CABG) without remote ischemic preconditioning protocol

Intervention Type PROCEDURE

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required. During extracorporal circulation patients receive isoflurane via a vaporizer incorporated in the extracorporeal gas supply in the same concentrations.

RIPC-OPCAB

Remote ischemic preconditioning (RIPC) protocol before Off-pump coronary artery bypass surgery (OPCAB) consists of 3 cycles of 5 minutes left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 minutes of reperfusion after induction of anesthesia before coronary artery bypass surgery. For myocardial molecular analyses, left ventricular biopsies are taken before first coronary artery incision and 5 to 10 Minutes after completion of the coronary anastomoses. Blood samples are taken up to 72 hours postoperatively.

Group Type ACTIVE_COMPARATOR

Remote ischemic preconditioning (RIPC)

Intervention Type PROCEDURE

3 cycles of 5 min left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 min reperfusion.

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required. In the CABG-arms, during extracorporal circulation patients receive isoflurane via a vaporizer incorporated in the extracorporeal gas supply in the same concentrations.

Control-OPCAB

Control group: Off-pump Coronary artery bypass surgery without RIPC protocol

Group Type PLACEBO_COMPARATOR

Off-pump Coronary artery bypass surgery without remote ischemic preconditioning

Intervention Type PROCEDURE

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required.

Interventions

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Remote ischemic preconditioning (RIPC)

3 cycles of 5 min left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 min reperfusion.

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required. In the CABG-arms, during extracorporal circulation patients receive isoflurane via a vaporizer incorporated in the extracorporeal gas supply in the same concentrations.

Intervention Type PROCEDURE

Coronary artery bypass grafting (CABG) without remote ischemic preconditioning protocol

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required. During extracorporal circulation patients receive isoflurane via a vaporizer incorporated in the extracorporeal gas supply in the same concentrations.

Intervention Type PROCEDURE

Off-pump Coronary artery bypass surgery without remote ischemic preconditioning

The applied anesthesia protocol avoids the use of propofol. Drugs: isoflurane+sufentanil anesthesia Anaesthesia is maintained by inhaled isoflurane in concentrations 0.7-0.8 % end-tidal with additional sufentanil injected during surgery, as required.

Intervention Type PROCEDURE

Other Intervention Names

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RIPC: remote ischemic preconditioning CABG: coronary artery bypass grafting OPCAB: Off-pump coronary artery bypass surgery Isoflurane: 2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-ethane, Forane Sufentanil, Sufenta, (R-30730)

Eligibility Criteria

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Inclusion Criteria

* Confirmed triple vessel coronary artery disease
* Indication for surgical coronary revascularisation
* Written informed consent
* Age ≥ 18 years

Exclusion Criteria

* Age \> 80 years
* Instable angina/acute coronary syndrome
* Emergency surgery
* Recent myocardial infarction within 7 days prior to surgery
* Recent major infection/sepsis within 7 days prior to surgery
* Significant hepatic, renal oder pulmonary disease
* Other concomitant surgical procedures
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Essen

OTHER

Sponsor Role collaborator

Heinrich-Heine University, Duesseldorf

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Payam Akhyari, MD

Role: PRINCIPAL_INVESTIGATOR

Dept. of Cardiovascular Surgery, University Hospital, Heinrich Heine University, Duesseldorf, Germany

Alexander Albert, MD

Role: PRINCIPAL_INVESTIGATOR

Dept. of Cardiovascular Surgery, University Hospital, Heinrich Heine University, Duesseldorf, Germany

Artur Lichtenberg, MD

Role: PRINCIPAL_INVESTIGATOR

Dept. of Cardiovascular Surgery, University Hospital, Heinrich Heine University, Duesseldorf, Germany

Gerd Heusch, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

nst. of Pathophysiology, University Duisburg-Essen, University Hospital Essen, Essen, Germany

Locations

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Dept. Cardiovascular Surgery, University Hospital, Heinrich Heine University

Düsseldorf, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Payam Akhyari, MD

Role: CONTACT

+492118118331

Artur Lichtenberg, MD

Role: CONTACT

+492118118331

Facility Contacts

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Payam Akhyari, MD

Role: primary

+492118118331

Alexander Albert, MD

Role: backup

+492118118331

References

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Hausenloy DJ, Erik Botker H, Condorelli G, Ferdinandy P, Garcia-Dorado D, Heusch G, Lecour S, van Laake LW, Madonna R, Ruiz-Meana M, Schulz R, Sluijter JP, Yellon DM, Ovize M. Translating cardioprotection for patient benefit: position paper from the Working Group of Cellular Biology of the Heart of the European Society of Cardiology. Cardiovasc Res. 2013 Apr 1;98(1):7-27. doi: 10.1093/cvr/cvt004. Epub 2013 Jan 19.

Reference Type BACKGROUND
PMID: 23334258 (View on PubMed)

Heusch G, Musiolik J, Kottenberg E, Peters J, Jakob H, Thielmann M. STAT5 activation and cardioprotection by remote ischemic preconditioning in humans: short communication. Circ Res. 2012 Jan 6;110(1):111-5. doi: 10.1161/CIRCRESAHA.111.259556. Epub 2011 Nov 23.

Reference Type BACKGROUND
PMID: 22116817 (View on PubMed)

Other Identifiers

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RIPCON-12

Identifier Type: -

Identifier Source: org_study_id

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