The objective of this study is to investigate the value of employing the aortic no-touch off-pump coronary artery bypass technique and the practice of carbon dioxide surgical field flooding for the prevention of type 1 and 2 neurological injuries following surgical coronary revascularization.
Neurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offset survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue, is off-pump CABG (OPCABG) that obviates the need for extracorporeal circulation and is associated with improved outcomes. The objective of this study is to examine whether the neuroprotective effect of OPCABG can be further pronounced by the use of two state-of-the-art operating techniques.
In this randomised, controlled, investigator and patient blinded single center superiority trial with three parallel arms a total of 360 patients will be recruited. They will be allocated in a 1:1:1 ratio to two treatment and one control arms. Treatment arms undergoing either aortic no-touch OPCABG or OPCABG with a partial clamp applying carbon dioxide surgical field flooding will be compared against control arm undergoing OPCABG. The primary endpoint will be the appearance of new lesions on control brain magnetic resonance imaging 3 days after surgery. Secondary endpoints will include the prevalence of new focal neurological deficits in the first 7 days after surgery, the occurrence of postoperative cognitive dysfunction at either 1 week or 3 months after surgery and the incidence of delirium in the first 7 days after surgery. Data will be analysed on intention-to-treat principles and a per protocol basis.
- Coronary Artery Disease
- Postoperative Cognitive Dysfunction
- Neurological Injury
- Postoperative Delirium
- Coronary Artery Bypass Surgery
- Off-Pump Coronary Artery Bypass
- Aortic no-touch OPCABG Procedure
Intervention Desc: (Study arm 1) In this intervention only the internal mammary artery grafts will be used (i.e. left internal mammary artery graft, right internal mammary artery graft, or a Y-graft that uses right internal mammary artery graft anastomosed onto left internal mammary artery graft to allow for a wide territory of myocardial revascularization). However, in the rare event that the aforementioned approach is insufficient to reach all target vessels, a reversed (great) saphenous vein graft may be used to extend the left internal mammary artery graft or the right internal mammary artery graft. ARM 1: Kind: Experimental Label: aortic no-touch OPCABG Description: aortic no-touch OPCABG
- OPCABG with partial clamp applying carbon dioxide Procedure
Intervention Desc: (Study arm 2) In this intervention chest cavity will be insufflated with carbon dioxide at a flow above 5 l/min during the entire surgical procedure. ARM 1: Kind: Experimental Label: OPCABG with partial clamp applying carbon dioxide Description: OPCABG with partial clamp applying carbon dioxide
- OPCABG with partial clamp Procedure
Intervention Desc: (Study arm 3) This is the control arm undergoing "traditional" OPCABG with partial clamp. ARM 1: Kind: Experimental Label: OPCABG with partial clamp Description: OPCABG with partial clamp
|Type||Measure||Time Frame||Safety Issue|
|Primary||New lesions on control brain magnetic resonance imaging.||3 days after surgery|
|Secondary||New focal neurological deficits.||7 days after surgery|
|Secondary||Occurence of postoperative cognitive dysfunction||1 week or 3 months after surgery|
|Secondary||Incidence of delirium||7 days after surgery|