Investigation Into the Role of GTN & RIPC in Cardiac Surgery

NCT ID: NCT01864252

Last Updated: 2019-09-25

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

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

192 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-31

Study Completion Date

2019-02-28

Brief Summary

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The purpose of this study is to determine whether Glyceryl Trinitrate (GTN) reduces injury to the heart during heart-lung bypass surgery in combination with the newer technique of remote ischaemic preconditioning (RIPC).

Detailed Description

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Ischaemic heart disease is a leading cause of mortality in the western world. A number of patients undergo coronary artery bypass graft (CABG) surgery as treatment for ischaemic heart disease. With the rise of interventional procedures, patients who are coming to have CABG surgery are higher risk1. Remote ischaemic preconditioning (RIPC) has been shown to reduce perioperative myocardial injury (PMI) in patients having CABG even when cold blood cardioplegia or intermittent cross clamp fibrillation is used as cardioprotective measures. These patients have a general anaesthetic with multiple infusions including Glyceryl Trinitrate (GTN). The use of GTN in these patients is based on theoretical assumptions of coronary vasodilation pre operatively along with maintaining graft potency postoperatively. We intend to investigate the effect of GTN in patients undergoing cardiac surgery being subjected to RIPC in its role as a Nitric Oxide (NO) donor. Exogenous NO has been shown to be cardioprotective in animal models.

Conditions

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Myocardial Reperfusion Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Group 1 Control (65 patients)

Sham Remote ischaemic preconditioning with IV normal saline 2-5ml/hour.

Group Type SHAM_COMPARATOR

IV Normal saline

Intervention Type DRUG

Normal saline IV started prior to knife to skin at a rate of 2-5 mls/h and stopped just after weaning off bypass.

Group 2 (65 patients)

Patients administered a Remote Ischaemic preconditioning protocol (three-5 min cycles of simultaneous inflation to cuffs placed on upper arm and thigh) prior to surgery and IV normal saline 2-5 mL/h during surgery.

Group Type ACTIVE_COMPARATOR

Remote ischaemic preconditioning

Intervention Type OTHER

3 cycles of 5 minutes to arm and legs

IV Normal saline

Intervention Type DRUG

Normal saline IV started prior to knife to skin at a rate of 2-5 mls/h and stopped just after weaning off bypass.

Group 3 GTN (65 patients):

Patients administered sham simulated Remote Ischaemic Preconditioning protocol prior to surgery and IV Glyceryl Trinitrate 2-5ml/h during surgery.

Group Type EXPERIMENTAL

IV Glyceryl trinitrate 2-5ml/h

Intervention Type DRUG

IV GTN given during surgery started prior to knife to skin and stopped after weaning off cardiopulmonary bypass.

• Group 4 RIPC+GTN (65 patients):

Patients administered Remote Ischaemic Preconditioning protocol and IV Glyceryl Trinitrate during surgery

Group Type EXPERIMENTAL

Remote ischaemic preconditioning

Intervention Type OTHER

3 cycles of 5 minutes to arm and legs

IV Glyceryl trinitrate 2-5ml/h

Intervention Type DRUG

IV GTN given during surgery started prior to knife to skin and stopped after weaning off cardiopulmonary bypass.

Interventions

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Remote ischaemic preconditioning

3 cycles of 5 minutes to arm and legs

Intervention Type OTHER

IV Normal saline

Normal saline IV started prior to knife to skin at a rate of 2-5 mls/h and stopped just after weaning off bypass.

Intervention Type DRUG

IV Glyceryl trinitrate 2-5ml/h

IV GTN given during surgery started prior to knife to skin and stopped after weaning off cardiopulmonary bypass.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years all patients admitted for on- pump CABG and/or valve surgery
* Able to give consent

Exclusion Criteria

* Allergies to excipients of IMP and placebo
* Chronic Renal failure (eGFR\<30 ml/min/kg)
* Severe liver disease
* Peripheral arterial disease
* Pregnant or lactating women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University College London Hospitals

OTHER

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Derek Yellon, PhD DSc FRCP

Role: PRINCIPAL_INVESTIGATOR

The Hatter Cardiovascular Institute

Locations

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The Heart Hospital, UCL Hospitals NHS Trust

London, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Hamarneh A, Sivaraman V, Bulluck H, Shanahan H, Kyle B, Ramlall M, Chung R, Jarvis C, Xenou M, Ariti C, Cordery R, Yellon DM, Hausenloy DJ. The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study. Clin Cardiol. 2015 Nov;38(11):641-6. doi: 10.1002/clc.22445. Epub 2015 Sep 28.

Reference Type DERIVED
PMID: 26412308 (View on PubMed)

Other Identifiers

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120541

Identifier Type: -

Identifier Source: org_study_id

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