MiECC Versus Conventional Cardiopulmonary Bypass in Cardiac Surgery (MiECS)

NCT ID: NCT05487612

Last Updated: 2024-08-07

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-26

Study Completion Date

2027-03-31

Brief Summary

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MiECS is one of the largest multicentre randomised controlled trials on extracorporeal circulation conducted under the auspices of Minimal Invasive Extracorporeal Technologies International Society (MiECTiS). It is designed to ultimately address the emerging effectiveness of MiECC systems in the light of modern perfusion practice worldwide. The primary hypothesis is that MiECC, as compared to conventional CPB (cCPB), reduces the proportion of patients experiencing serious perfusion-related postoperative morbidity after cardiac surgery. The study will be led by the Clinical Research Unit of the Special Unit for Biomedical Research and Education (SUBRE), Aristotle University of Thessaloniki School of Medicine in Greece (AUSoM) with Chief Investigator Professor Kyriakos Anastasiadis, who is a key-opinion-leader in the field of MiECC, founder and Executive Board of MiECTiS.

Detailed Description

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Despite a fall in mortality rates over the past decade, patients having cardiac surgery continue to experience serious postoperative complications. The risk of serious and relatively common surgical complications is often a consequence of stopping the heart during the operation, using the heart and lung machine (conventional cardiopulmonary bypass; cCPB), and restarting and reperfusing the heart at the end of the operation. Although several strategies have been developed to reduce such complications, they still occur and can be life threatening; they also increase the length of time a patient spends in the hospital.

Miniaturised heart lung machines (minimally invasive extracorporeal circulation; MiECC) have been developed with the aim of reducing the number of postoperative complications arising from using cCPB. Because of the variety of miniaturised systems that have been evaluated, the different types of patients and outcomes investigated, and the poor quality of previous studies, the effectiveness of MiECC in reducing postoperative complications has not been established and most hospitals continue to use cCPB.

Our primary hypothesis is that, compared to cCPB, using a MiECC system during cardiac surgery reduces the proportion of patients having one of several serious postoperative complications (death, myocardial infarction, stroke, acute kidney injury, reintubation, tracheostomy, mechanical ventilation for more than 48 hours, or reoperation) up to 30 days after surgery. In addition, the investigators hypothesise that MiECC reduces the amount of blood products transfused, time to discharge from the cardiac intensive care unit and hospital and the health care resources used during the hospital stay.

Study investigators propose to carry out a large, multicentre randomised controlled trial in 10 to 15 cardiac surgery centres worldwide. Patients will be eligible if they are having coronary artery bypass surgery, aortic valve replace or both using a heart lung machine without circulatory arrest. Centres may recruit patients having all, or a subset of, operation types.

It is expected that 20 % to 23% of patients will experience one or more of the serious complications (the primary outcome). In order to be able confidently to detect a 30% relative reduction in the risk of this outcome, the investigators plan to recruit 1,300 participants across all sites.

Conditions

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Coronary Artery Disease Aortic Valve Stenosis Extracorporeal Circulation; Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or both procedures CABG+AVR using extracorporeal circulation without circulatory arrest will be randomised (1:1 ratio) to having surgery using Minimal Invasive Extracorporeal Circulation (MiECC) or conventional cardiopulmonary bypass (cCPB).
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Minimal Invasive Extracorporeal Circulation (MiECC)

Patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), or combined procedure (AVR+CABG) with Minimal Invasive Extracorporeal Circulation (MiECC).

Group Type ACTIVE_COMPARATOR

Minimal Invasive Extracorporeal Circulation

Intervention Type DEVICE

Cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC).

Conventional Cardiopulmonary Bypass (cCPB)

Patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), or combined procedure (AVR+CABG) with conventional cardiopulmonary bypass (cCPB)

Group Type ACTIVE_COMPARATOR

Conventional cardiopulmonary bypass

Intervention Type DEVICE

Cardiac surgery with conventional cardiopulmonary bypass (cCPB).

Interventions

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Minimal Invasive Extracorporeal Circulation

Cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC).

Intervention Type DEVICE

Conventional cardiopulmonary bypass

Cardiac surgery with conventional cardiopulmonary bypass (cCPB).

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* All patients undergoing any elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or CABG+AVR surgery using extracorporeal circulation without circulatory arrest.

Exclusion Criteria

* Requirement for emergency or salvage operation.
* Requirement for major aortic surgery (e.g. aortic root replacement).
* Contraindication or objection (e.g. Jehovah's Witnesses) to transfusion of blood products.
* Congenital or acquired platelet, red cell or clotting disorders (patients with iron deficient anaemia will not be excluded).
* Inability to give informed consent for the study (e.g. learning or language difficulties).
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Minimal Invasive Extracorporeal Technologies International Society (MiECTiS)

UNKNOWN

Sponsor Role collaborator

Aristotle University Of Thessaloniki

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kyriakos Anastasiadis, Professor

Role: STUDY_CHAIR

Aristotle University Of Thessaloniki

Polychronis Antonitsis, Assoc. Prof.

Role: STUDY_DIRECTOR

Aristotle University Of Thessaloniki

Locations

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Perfusion Services University Health Network, Toronto General Hospital

Toronto, , Canada

Site Status RECRUITING

Department of Cardiac Surgery

Coswig, , Germany

Site Status ACTIVE_NOT_RECRUITING

Department of Thoracic and Cardiovascular Surgery, University Medical Centre Goettingen

Göttingen, , Germany

Site Status ACTIVE_NOT_RECRUITING

Department of Cardiothoracic and Vascular Surgery, Ulm University Hospital

Ulm, , Germany

Site Status COMPLETED

Cardiothoracic Department AHEPA University Hospital

Thessaloniki, , Greece

Site Status RECRUITING

Department of Cardiac Surgery GVM Anthea Hospital

Bari, , Italy

Site Status RECRUITING

Department of Cardiac Surgery GVM Maria Eleonora Hospital

Palermo, , Italy

Site Status ACTIVE_NOT_RECRUITING

Department of Cardiovascular Surgery, Ankara City Hospital

Ankara, , Turkey (Türkiye)

Site Status ACTIVE_NOT_RECRUITING

Department of Cardiovascular Surgery, Izmir Bakırçay University, Faculty of Medicine

Izmir, , Turkey (Türkiye)

Site Status RECRUITING

Department of Cardiac Surgery, Royal Papworth Hospital

Cambridge, , United Kingdom

Site Status ACTIVE_NOT_RECRUITING

Deparment of Cardiac Surgery, Castle Hill Hospital

Hull, , United Kingdom

Site Status ACTIVE_NOT_RECRUITING

Department of Cardiothoracic Surgery, Hammersmith Hospital

London, , United Kingdom

Site Status ACTIVE_NOT_RECRUITING

Countries

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Canada Germany Greece Italy Turkey (Türkiye) United Kingdom

Central Contacts

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Georgios Papazisis, Assoc. Prof.

Role: CONTACT

+30 2310999323

Facility Contacts

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Vivek Rao

Role: primary

Mousumi Mahanta

Role: backup

416-340-4800 ext. 5275

Polychronis Antonitsis, Assoc. Prof.

Role: primary

+30 2310994871

Giuseppe Nasso, MD

Role: primary

+39 347 8159 178

Ahmet Daylan, Ass. Prof.

Role: primary

Sahin Bozok, Prof.

Role: backup

References

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Anastasiadis K, Murkin J, Antonitsis P, Bauer A, Ranucci M, Gygax E, Schaarschmidt J, Fromes Y, Philipp A, Eberle B, Punjabi P, Argiriadou H, Kadner A, Jenni H, Albrecht G, van Boven W, Liebold A, de Somer F, Hausmann H, Deliopoulos A, El-Essawi A, Mazzei V, Biancari F, Fernandez A, Weerwind P, Puehler T, Serrick C, Waanders F, Gunaydin S, Ohri S, Gummert J, Angelini G, Falk V, Carrel T. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS). Interact Cardiovasc Thorac Surg. 2016 May;22(5):647-62. doi: 10.1093/icvts/ivv380. Epub 2016 Jan 26.

Reference Type BACKGROUND
PMID: 26819269 (View on PubMed)

Anastasiadis K, Antonitsis P, Asteriou C, Deliopoulos A, Argiriadou H. Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature. Perfusion. 2022 Nov;37(8):852-862. doi: 10.1177/02676591211026514. Epub 2021 Jun 17.

Reference Type BACKGROUND
PMID: 34137323 (View on PubMed)

COMICS investigators, The COMICS investigators. Conventional versus minimally invasive extracorporeal circulation in patients undergoing cardiac surgery: protocol for a randomised controlled trial (COMICS). Perfusion. 2021 May;36(4):388-394. doi: 10.1177/0267659120946731. Epub 2020 Aug 12.

Reference Type BACKGROUND
PMID: 32781894 (View on PubMed)

Wahba A, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Puis L; EACTS/EACTA/EBCP Committee Reviewers. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg. 2020 Feb 1;57(2):210-251. doi: 10.1093/ejcts/ezz267. No abstract available.

Reference Type BACKGROUND
PMID: 31576396 (View on PubMed)

Ranucci M, Johnson I, Willcox T, Baker RA, Boer C, Baumann A, Justison GA, de Somer F, Exton P, Agarwal S, Parke R, Newland RF, Haumann RG, Buchwald D, Weitzel N, Venkateswaran R, Ambrogi F, Pistuddi V. Goal-directed perfusion to reduce acute kidney injury: A randomized trial. J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927.e2. doi: 10.1016/j.jtcvs.2018.04.045. Epub 2018 Apr 18.

Reference Type BACKGROUND
PMID: 29778331 (View on PubMed)

Anastasiadis K, Argiriadou H, Deliopoulos A, Antonitsis P. Minimal invasive extracorporeal circulation (MiECC): the state-of-the-art in perfusion. J Thorac Dis. 2019 Jun;11(Suppl 10):S1507-S1514. doi: 10.21037/jtd.2019.01.66. No abstract available.

Reference Type BACKGROUND
PMID: 31293801 (View on PubMed)

Kowalewski M, Pawliszak W, Raffa GM, Malvindi PG, Kowalkowska ME, Zaborowska K, Kowalewski J, Tarelli G, Taggart DP, Anisimowicz L. Safety and efficacy of miniaturized extracorporeal circulation when compared with off-pump and conventional coronary artery bypass grafting: evidence synthesis from a comprehensive Bayesian-framework network meta-analysis of 134 randomized controlled trials involving 22 778 patients. Eur J Cardiothorac Surg. 2016 May;49(5):1428-40. doi: 10.1093/ejcts/ezv387. Epub 2015 Nov 3.

Reference Type BACKGROUND
PMID: 26537755 (View on PubMed)

Anastasiadis K, Antonitsis P, Papazisis G, Haidich B, Liebold A, Punjabi P, Gunaydin S, El-Essawi A, Rao V, Serrick C, Condello I, Nasso G, Bozok S, Daylan A, Argiriadou H, Deliopoulos A, Karapanagiotidis G, Ashkanani F, Moorjani N, Cale A, Erdoes G, Bennett M, Starinieri P, Carrel T, Murkin J. Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial. Perfusion. 2025 May;40(4):923-932. doi: 10.1177/02676591241272009. Epub 2024 Aug 1.

Reference Type BACKGROUND
PMID: 39089011 (View on PubMed)

Related Links

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https://miectis.e-dendrite.com

MiECS Clinical Trial Registry by Dendrite

Other Identifiers

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MiECS

Identifier Type: -

Identifier Source: org_study_id

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