Genetic Determinants of Congenital Heart Disease Outcomes

Congenital Heart Disease Clinical Trial

— GECHO  

Official title:

The GECHO Trial: Genetic Determinants of Congenital Heart Disease Outcomes

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01656941
• Other study ID #: GECHO
• Status: Completed
• Start date: March 2011
• Est. completion date: March 16, 2017

Study information

• Verified date: August 2021
• Source: University of Michigan
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The purpose of this study is to examine the role of genetic variation in the oxidative stress response on critical perioperative and short-term outcomes after neonatal heart surgery. The goals will be to determine 1) if the oxidative stress pathway is an important one for therapeutic intervention in neonates with severe congenital heart defects and 2) if variants in the oxidative response pathway can be used to identify patients at increased risk for adverse outcomes.

Description:

For physicians caring for children with congenital cardiac defects, perhaps the greatest challenge is to improve the survival and functional outcomes of patients with severe defects requiring surgical repair or palliation in the first month of life. These cardiac defects can be associated with 5 year mortality rates of up to 30% with significant disabilities in many of the survivors. As with every medical condition, patient outcomes depend on the complex interaction of the disease process, the medical and surgical interventions to treat the disease, and the inherent capacity of the patient to respond to both the disease and its treatment.

For patients with severe cardiac defects, the greatest risk for morbidity and mortality occurs during and shortly after their neonatal surgical repair. During surgery to repair severe cardiac defects, the body is cooled and the heart is stopped. In many cases, blood flow to the vital organs is interrupted or restricted for a significant period of time while the aortic arch is reconstructed. This process places profound stress on the patient's capacity to tolerate these insults without sustaining irreversible injury to tissues such as the heart, brain, and kidneys. That there is such a wide range of outcomes after this surgery, even between patients with similar clinical features, suggests that there are important individual differences in patients' abilities to respond to this stress that is determined by differences in their genetic traits.

The importance of the interaction between the controlled trauma of the surgical environment and a patient's genetic background in determining patient outcomes has led to the new discipline of "peri-operative genomics." In this study, we will examine the contribution of gene-environment interactions to perioperative and short-term outcomes in neonates with severe congenital cardiac defects.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 250
• Est. completion date: March 16, 2017
• Est. primary completion date: March 16, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 30 Days

Eligibility

Inclusion Criteria:

• d-transposition of the great arteries or single ventricle cardiac disease

• Less than or equal to 30 days of age

• Planned arterial switch operation or stage I surgical palliation (Norwood)with aortic arch reconstruction

Exclusion Criteria:

• Known trisomy 13, 18, or 21

• Any major non-cardiac anomaly that precludes the patient from cardiac surgery

Related Conditions & MeSH terms

• Congenital Heart Disease
• d-Transposition of the Great Arteries
• Heart Defects, Congenital
• Heart Diseases
• Hypoplastic Left Heart Syndrome
• Hypoplastic Right Heart Syndrome
• Syndrome
• Transposition of Great Vessels

Locations

Country	Name	City	State
Australia	The Royal Children's Hospial Melbourne	Melbourne	Victoria
United States	C.S. Mott Children's Hospital, University of Michigan Health System	Ann Arbor	Michigan
United States	Emory University	Atlanta	Georgia
United States	Medical University of South Carolina	Charleston	South Carolina
United States	Medical College of Wisconsin	Milwaukee	Wisconsin

Sponsors (5)

Lead Sponsor	Collaborator
University of Michigan	Emory University, Medical College of Wisconsin, Medical University of South Carolina, Royal Children's Hospital

Countries where clinical trial is conducted

United States,  Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Contribution of genetic variation in oxidative stress management to differences in short term outcomes after repair for severe cardiac disease in the neonatal period	Genotyping will be performed on 10 variants in the oxidative stress response pathway and we will combine risk genotypes in order to evaluate the cumulative effect of both detrimental and beneficial alleles on post-operative outcomes.; Composite short term outcome measure includes: ICU length of stay (days) Time to initial extubation (hours) Cardiac arrest or ECMO support (Y/N) Delayed sternal closure (Y/N) Serious adverse event (Y/N) Greater than 1 serious adverse event (Y/N)	Duration of initial perioperative hospitalization (~2-4 weeks)
Secondary	Contribution of genetic variation in oxidative stress management to differences in interstage mortality and pre-Stage II cardiovascular function in patients with single ventricle cardiac disease	Composite outcome; Growth parameters (height, weight, head circumference); AV valve insufficiency (By echocardiogram and cardiac catheterization) , Ventricular function (ejection fraction by echocardiogram and by cardiac catheterization), Central venous pressure and ventricular end diastolic pressure (by catheterization), Interstage Death (Y/N).	Interval from hospital discharge following stage I surgical palliation until hospital admission for stage II surgical palliation (~4-6 months of age)