Retrograde Versus Antegrade Perfusion in Low-Moderate Hypothermia for Aortic Arch Surgery

NCT ID: NCT06986967

Last Updated: 2025-08-15

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

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-04-18

Study Completion Date

2027-03-31

Brief Summary

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The purpose of this study is to compare brain function after surgical circulatory arrest using either antegrade perfusion or retrograde perfusion.

Detailed Description

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The purpose of this study is to compare brain function after surgical circulatory arrest (surgeon stops the heart-lung machine to work on the heart) in antegrade perfusion versus retrograde perfusion. There are 2 ways to supply blood to the brain, antegrade and retrograde perfusion. In antegrade perfusion, the surgeon accesses one of two arteries that branch off from the aorta (the artery that delivers blood to the rest of the body) to provide blood to the brain. In retrograde perfusion, the surgeon accesses the superior vena cava (large vein bringing blood back to the heart) to supply blood to the brain.

It is standard practice to cool the patient down during this type of surgery to help protect the brain. Despite measures to safeguard brain health, some patients still experience postoperative cognitive decline such as confusion, delirium and agitation. The investigators are conducting this study to see which method of perfusing the brain is superior and decreases the symptoms of confusion, delirium and agitation.

Conditions

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Brain Function Hemiarch Cardiac Procedure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
The neuroimaging personnel will be blinded to the assignment of the subject.

Study Groups

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Arm 1: Antegrade Perfusion

In antegrade perfusion, the surgeon accesses one of two arteries that branch off from the aorta (the artery that delivers blood to the rest of the body) to provide blood to the brain.

Group Type ACTIVE_COMPARATOR

Antegrade Perfusion

Intervention Type PROCEDURE

Procedure in which the surgeon accesses one of two arteries that branch off from the aorta to provide blood to the brain.

Arm 2: Retrograde Perfusion

In retrograde perfusion, the surgeon accesses the superior vena cava (large vein bringing blood back to the heart) to supply blood to the brain.

Group Type ACTIVE_COMPARATOR

Retrograde Perfusion

Intervention Type PROCEDURE

Procedure in which the surgeon accesses the superior vena cava to supply blood to the brain.

Interventions

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Antegrade Perfusion

Procedure in which the surgeon accesses one of two arteries that branch off from the aorta to provide blood to the brain.

Intervention Type PROCEDURE

Retrograde Perfusion

Procedure in which the surgeon accesses the superior vena cava to supply blood to the brain.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. \> 18 years of age
2. Participant's that are scheduled for elective proximal aortic reconstructive surgery (ascending aorta + aortic valve or root) with concomitant proximal hemi-arch replacement via median sternotomy

Exclusion Criteria

1. \< 18 years of age
2. history of symptomatic cerebrovascular disease, e.g., prior stroke with residual deficit
3. current alcoholism (\> 2 drinks/day)
4. current psychiatric illness requiring pharmacotherapy
5. current drug abuse (any illicit drug use in the past 3 months)
6. hepatic insufficiency (liver function tests \> 1.5 times the upper limit of normal)
7. severe pulmonary insufficiency (requiring home oxygen therapy)
8. renal failure (serum creatinine \> 2.0 mg/dL)
9. claustrophobic fear
10. unable to read and thus unable to complete the cognitive testing
11. pregnant women
12. patients who score \<19 om the Montreal Cognitive Assessment (MoCA) or ≥27 on the baseline Center for Epidemiological Studies Depression (CES-D) scale
13. patients who have pre-existing unsafe implants for 3 Tesla magnetic resonance imaging (MRI)
14. Patients who have received chemotherapy in the last 12 months or radiation to the brain
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Duke University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Joseph Mathew, M.D.

Role: STUDY_CHAIR

Duke University

Locations

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Duke Univeristy

Durham, North Carolina, United States

Site Status NOT_YET_RECRUITING

Duke Univeristy

Durham, North Carolina, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Kelly Rodden, BSN

Role: CONTACT

9196811804

Bonita Hilliard, RPM

Role: CONTACT

Facility Contacts

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Kelly Rodden, BSN

Role: primary

919-681-1804

Kelly Dr. Mathew, MD

Role: primary

919-681-1804

Other Identifiers

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Pro00116844

Identifier Type: -

Identifier Source: org_study_id

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