Remote Ischemic Conditioning to Attenuate Myocardial Death and Improve Operative Outcome.

NCT ID: NCT03363958

Last Updated: 2017-12-06

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

PHASE2

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-01

Study Completion Date

2020-01-01

Brief Summary

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This study evaluates the addition of remote ischemic preconditioning and postconditioning to standard myocardial protection protocol in patients submitted to off - pump coronary artery bypass grafting in a prospective, 1:1 randomized, double blind fashion. An interventional group will receive remote ischemic preconditioning 24-hours before OP-CABG, immediately before surgery and within 60 minutes following surgery by means of lower limb ischemia achieved by pressure cuff inflation, whereas control group will receive sham procedure perioperatively.

Detailed Description

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In a prospective, 1:1 randomized and double blind fashion, the study will evaluate the impact of remote ischemic preconditioning, both immediate and second window of protection (24 hours and immediately before surgery) with remote ischemic postconditiong on operative outcomes in patients submitted to coronary artery bypass grafting without use of extracorporeal circulation.

Remote ischemic conditioning was found to provide protection against necrosis and apoptosis due to ischemia and reperfusion injury, a phenomenon observed during coronary artery bypass grafting. That in turn was associated with poor postoperative outcomes, predominantly poor survival.

Remote ischemic preconditioning will be provided by repeated lower leg ischemia and reperfusion with pressure cuff inflation for five minutes and deflation for five minutes in three consecutive cycles. Remote ischemic preconditioning will be performed 24 hours before CABG and immediately before surgery. Remote ischemic postconditioning will be performed within 60 minutes following the last coronary artery bypass graft completion and the restoration of coronary blood flow.

The study will assess clinical endpoints such as postoperative acute myocardial infarction (type 5 MI), postoperative mortality, postoperative renal failure and laboratory outcomes such as postoperative serial measurements of troponin T release or glomerular filtration rate as secondary outcomes.

Conditions

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Coronary Artery Bypass Myocardial Reperfusion Injur Ischemic Preconditioning, Myocardial Ischemic Postconditioning

Keywords

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myocardial protection remote ischemic preconditioning remote ischemic postconditioning cardiac surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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RIC Group

Three cycles of remote ischemic conditioning (5minutes ischemia and 5minutes reperfusion; lower leg ischemia achieved by pressure cuff inflation and deflation); First three cycles the patient will receive 24 hours preoperatively, second three cycles the patient will receive after the induction of general anesthesia but before skin incision shortly before CABG. Remote ischemic postconditioning (5minutes ischemia and 5minutes reperfusion; lower leg ischemia achieved by pressure cuff inflation and deflation) will be administered to the patient within 60 minutes after the completion of all coronary artery bypass grafts and the restoration of coronary blood flow.

Group Type EXPERIMENTAL

Remote Ischemic Preconditioning with Postconditioning

Intervention Type PROCEDURE

Three cycles of 5 minutes of ischemia and 5 minutes of reperfusion of lower leg 24 hours, immediately before surgery and within 60 minutes after the restoration of coronary blood flow postoperatively.

Control Group

Control group will receive sham procedure near identical to intervention. That will be afforded by inflation of pressure cuff on artificial leg hidden under the draping by an assistant who is not included in the research team and does not have any connection to study design and data analysis.

Group Type SHAM_COMPARATOR

Sham RIPC procedure

Intervention Type PROCEDURE

Three cycles of 5 minutes of inflation and 5 minutes of deflation of artificial lower leg immediately before surgery and within 60 minutes after the restoration of coronary blood flow postoperatively.

Interventions

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Remote Ischemic Preconditioning with Postconditioning

Three cycles of 5 minutes of ischemia and 5 minutes of reperfusion of lower leg 24 hours, immediately before surgery and within 60 minutes after the restoration of coronary blood flow postoperatively.

Intervention Type PROCEDURE

Sham RIPC procedure

Three cycles of 5 minutes of inflation and 5 minutes of deflation of artificial lower leg immediately before surgery and within 60 minutes after the restoration of coronary blood flow postoperatively.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Patients qualified to coronary artery bypass grafting according to ESC/EACTS Guidelines of myocardial revascularization, suffering from:

* Multivessel coronary artery disease amenable for surgical treatment
* Negative history of previous cardiac or vascular surgery in childhood and afterwards.
* Negative history of active neoplastic disease, neither past medical history of oncological treatment
* Patients with non insulin dependent diabetes mellitus treated chronically with oral derivatives of sulfonylourea such as but not limited to: glibenclamide.

Exclusion Criteria

Patients suffering from acute insuficiency of any organ/ system and those suffering from end stage organ failure such as:

* Chronic renal disease - KDOQI stage ≥ 3;
* Chronic renal failure class A by Child - Pugh'a;
* Chronic respiratory failure (type I and II according to Campbell et al. and type I according to Wood et al.);
* Chronic intermittent claudication class 2A according to Fontaine;
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medinet Heart Centre

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jakub S. Marczak, M.D.

Role: PRINCIPAL_INVESTIGATOR

Medinet Heart Center

Locations

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Medinet Heart Centre

Nowa Sól, Lubusz Voivodeship, Poland

Site Status RECRUITING

Countries

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Poland

Central Contacts

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Jakub S. Marczak, M.D.

Role: CONTACT

Phone: 0048883774566

Email: [email protected]

Sleiman S. Aboul - Hassan, M.D.

Role: CONTACT

Phone: 0048683882194

Email: [email protected]

Facility Contacts

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Sleiman Sebastian Aboul-Hassan, MD

Role: primary

References

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Marczak J, Nowicki R, Kulbacka J, Saczko J. Is remote ischaemic preconditioning of benefit to patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg. 2012 May;14(5):634-9. doi: 10.1093/icvts/ivr123. Epub 2012 Jan 26.

Reference Type BACKGROUND
PMID: 22286602 (View on PubMed)

Related Links

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http://medinet.pl

Related Info

Other Identifiers

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RIPC Trial

Identifier Type: -

Identifier Source: org_study_id