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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05344573
Other study ID # 20-2465
Secondary ID K23HL151882
Status Recruiting
Phase
First received
Last updated
Start date July 5, 2022
Est. completion date July 1, 2025

Study information

Verified date January 2024
Source University of Colorado, Denver
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Cardiopulmonary bypass during cardiac surgery provides blood flow to the body during surgery but has adverse effects on different organs. Blood flow during cardiopulmonary bypass may be pulsatile or non-pulsatile, which may impact normal organ function after surgery. The study will collect data on the type of cardiopulmonary bypass used during surgery and organ function to determine if there is an association between the type of bypass and organ function.


Description:

Cardiac surgery is a high-risk elective surgical procedure frequently requiring CPB in which a machine pumps blood while the surgeon operates on the heart. CPB contributes to surgical risk by causing endothelial dysfunction and acute kidney injury (AKI). Endothelial dysfunction and AKI happen because heart lung machines typically generate non-pulsatile blood flow, which is abnormal and results in impaired tissue oxygen delivery. Normal blood flow is pulsatile due intermittent contraction and relaxation of the heart during the cardiac cycle, which produces a mechanical signal that induces endothelial cells to produce nitric oxide. Without nitric oxide, blood flow does not penetrate as deeply into organs such as the kidneys which leads to acute kidney injury. AKI increases mortality 10-fold after cardiac surgery placing many people at risk since over 400,000 people have surgery with CPB each year in the United States. Thus, pulsatile CPB may influence endothelial function and renal blood flow after cardiac surgery. This study will observe patients undergoing cardiac surgery with CPB and compare patients who receive pulsatile or non-pulsatile CPB.


Recruitment information / eligibility

Status Recruiting
Enrollment 66
Est. completion date July 1, 2025
Est. primary completion date December 1, 2024
Accepts healthy volunteers No
Gender All
Age group 50 Years to 70 Years
Eligibility Inclusion Criteria: - Age 50 to 70 - Able to provide informed consent - Scheduled for elective cardiac surgery with cardiopulmonary bypass Exclusion Criteria: - Patients undergoing emergency procedures - Diagnosed with sepsis - Experiencing delirium - Experiencing hemodynamic instability (heart rate > 100 and systolic blood pressure < 90) - Patients with a mechanical circulatory support device - Requiring vasoactive medications before surgery - Patients with a reduced left ventricular ejection fraction (less than 50%) - Patients with a contraindication to transesophageal echocardiography

Study Design


Related Conditions & MeSH terms


Locations

Country Name City State
United States University of Colorado Hospital Aurora Colorado

Sponsors (2)

Lead Sponsor Collaborator
University of Colorado, Denver National Heart, Lung, and Blood Institute (NHLBI)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Endothelial function Percent change in flow mediated dilation of the brachial artery after cardiac surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Acute kidney injury Acute kidney injury by the KDIGO criteria From intensive care unit admission after surgery to intensive care unit discharge, up to 7 days
Secondary Renal blood flow velocity Renal blood flow velocity measured by pulse wave doppler Intra-operative time point: after cardiopulmonary bypass, up to 12 hours
Secondary Acute kidney injury risk Acute kidney injury risk measured by urinary TIMP2*IGFBP7 Measured 4 hours after the end of cardiopulmonary bypass, up to 12 hours
Secondary Perioperative death Death after surgery during the surgical hospital encounter From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Myocardial infarction Myocardial infarction after surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Stroke Stroke after surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New renal failure requiring renal replacement therapy New renal failure requiring renal replacement therapy after surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Re-exploration for bleeding Need for surgical re-exploration to control hemorrhage From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative sepsis Post-operative sepsis determined by positive blood culture From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New onset atrial fibrillation Post-operative new onset atrial fibrillation From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative blood loss Post-operative blood loss determined by total surgical drain output From intensive care unit admission to 24 hours after intensive care unit admission, up to 24 hours
Secondary Duration of mechanical ventilation Duration of mechanical ventilation after surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative delirium Post-operative delirium determined by the Confusion Assessment Method for the Intensive Care Unit score From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative hospital length of stay Duration of hospital stay after surgery From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New requirement for mechanical circulatory support Post-operative initiation of mechanical circulatory support From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Intra-operative red blood cell transfusion Intra-operative red blood cell transfusion in units During the intra-operative time period, up to 12 hours
Secondary Post-operative red blood cell transfusion Post-operative red blood cell transfusion in units From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative platelet transfusion Post-operative platelet transfusion in units From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative plasma transfusion Post-operative plasma transfusion in units From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Post-operative cryoprecipitate transfusion Post-operative cryoprecipitate transfusion in units From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary Intra-operative platelet transfusion Intra-operative platelet transfusion in units During the intra-operative time period, up to 12 hours
Secondary Intra-operative plasma transfusion Intra-operative plasma transfusion in units During the intra-operative time period, up to 12 hours
Secondary Intra-operative cryoprecipitate transfusion Intra-operative cryoprecipitate transfusion in units During the intra-operative time period, up to 12 hours
Secondary Glycocalyx thickness Glycocalyx thickness determined by sublingual microcirculation microscopy Start of the intra-operative period to 24 hours after intensive care unit admission
Secondary Microvascular circulatory function Microvascular circulatory function determined by sublingual microcirculation microscopy Start of the intra-operative period to 24 hours after intensive care unit admission
Secondary New onset of acute lung injury Diagnosis of acute lung injury by PaO2 to FiO2 ratio From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New onset of left ventricular diastolic dysfunction Diagnosis new onset diastolic dysfunction by annular e' velocity: septal e' < 7 cm/sec, lateral e' <10 cm/sec, average E/e' ratio > 14, LA volume index > 34 mL/m2, and peak TR velocity > 2.8 m/sec. From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New onset of left ventricular systolic dysfunction New onset of left ventricular systolic dysfunction determined by a LV ejection fraction <50% From intensive care unit admission after surgery to hospital discharge, up to 30 days
Secondary New onset of right ventricular systolic dysfunction New onset of right ventricular systolic dysfunction determined by a tricuspid annular plane systolic excursion less than 16 mm From intensive care unit admission after surgery to hospital discharge, up to 30 days
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