Clinical Trials Logo

Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT05389865
Other study ID # IRAS 309277
Secondary ID
Status Not yet recruiting
Phase
First received
Last updated
Start date August 2023
Est. completion date August 2024

Study information

Verified date May 2023
Source Golden Jubilee National Hospital
Contact George Gradinariu, MD
Phone 01419515000
Email george.gradinariu2@nhs.scot
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The aorta is the principal arterial vessel arising from the left heart that transfers blood to the body. Certain genetic and familial disease processes are known to weaken the aortic wall resulting in dilation and potential rupture. These aortic complications carry high mortality (>25%) and current management is orientated towards early detection and preventive treatment. Aortic dilation can also result in aortic valve dysfunction leading to heart failure. The estimated UK incidence of aortic disease per year is around 10 per 100,000 individuals, with 2000 people per year dying from aortic complications. The 2017-2020 National Adult Cardiac Surgery Audit report identified the number of people receiving surgery for aortic dissection in Scotland is per population proportionately lower compared to England (4.6 per million per year in Scotland vs. 6.6 per million per year in England). The reasons for this are unclear but may relate to the prevalence of aortic disease or a large geographic distribution with compromised access to specialized centres. Currently surgery is recommended when the aortic diameter exceeds a certain threshold. There are several types of effective surgical procedures, but there is still limited information on their long-term outcomes and the advantage of one procedure over another. The aims of the project are firstly to determine the clinical outcomes of the surgical procedures that are currently employed in Scotland to treat proximal aortic disease and secondly to describe the prevalence and distribution of proximal aortic disease within the Scottish population. The project will be hosted by the Golden Jubilee Research Institute. Contemporary and retrospective data will be collected from all the Scottish Cardiothoracic Surgery units which are based in Glasgow, Edinburgh and Aberdeen. This will be the first study to analyse surgical outcomes for ascending aortic disease in Scotland, and the first to describe the epidemiology of aortic disease within the population. It is anticipated that the results will guide current surgical practise, and provide data to inform national service provision for the management of proximal aortic disease.


Description:

The study has two principal aims: 1. Determine the patient demographics, procedural types and related clinical outcomes in patients who underwent surgery of the proximal thoracic aorta in Scotland 2. Describe the epidemiology of proximal aortopathy within the Scottish population, by determining the prevalence of disease, geographic distribution and patient demographics This study will be the first to look at outcomes from a nation-wide cohort of patients following surgery of the thoracic aorta in the UK. The investigators anticipate that results from this study will inform future aortic practice and guide decisions on intervention timing and type. Information on the prevalence and geographic distribution of aortic disease within Scotland will guide resource allocation and service configuration to allow equity in access to treatment. By raising awareness among the medical professionals and the wider community, the study should lead to improved recognition and better outcomes for patients with aortic disease. Data will be recorded in a contemporary and retrospective manner for two patient cohorts: 1. Surgical cohort - Adult patients who have had a surgical intervention on the proximal aorta in the three Scottish Cardiothoracic Surgery units based in Glasgow, Edinburgh, Aberdeen in the last 13 years (2008 - 2021). 2. Non-surgical cohort - Adult patients who have a diagnosis of proximal aortopathy, but have not had surgery. This cohort will be obtained from three sources: 1. Patients with a diagnosis of thoracic aortopathy identified via National Interim Clinical Imaging Procedure (NICIP) codes sourced from the Scottish Radiology Information System (RIS) and Picture Archive and Communication System (PACS) databases. 2. Patients with a diagnosis of thoracic aortopathy identified from regional genetic services via the Network for Inherited Cardiac Conditions Scotland. 3. Deceased patients diagnosed with proximal thoracic aortopathy or a complication thereof (aortic dissection, aortic rupture) registered at death certification and/or post mortem accessed from Public Health Scotland using ICD-10 codes. The three data collection sites will be the Golden Jubilee National Hospital in Glasgow, the Edinburgh Royal Infirmary and Aberdeen Royal Infirmary. The surgical cohort sample size is expected to be around 1300 patients. The non-surgical cohort is difficult to estimate, but around 500 cases yearly are expected to be identified. The research project will be hosted by the NHS Golden Jubilee Research Department. The principal investigator (George Gradinariu) will undertake this research project as part of an postgraduate research programme (MD degree) at the University of Glasgow under the supervision of Professor Mark Danton (Congenital Cardiac Surgeon with interest in proximal aortic surgery), Professor Alex McConnachie Professor of Biostatistics, University of Glasgow) and Professor Faisal Ahmed (Samson Gemmell Chair of Child Health, University of Glasgow) Statistical analysis will be overseen and supervised by Professor McConnachie. Descriptive statistics will be applied. Survival data will be analysed using Kaplan-Meier. Multivariable survival and logistic regression models will be used to identify variables predicting the risk of adverse outcomes. Predictive modelling to estimate the risk of adverse outcomes based on aortic root dimension will be assessed using ROC analysis. In comparing survival by procedures propensity matching will be used to minimize confounding. Analysis will be performed using R statistical analysis software (R Foundation for Statistical Computing, Vienna, Austria).


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 2000
Est. completion date August 2024
Est. primary completion date August 2024
Accepts healthy volunteers
Gender All
Age group 18 Years and older
Eligibility Surgical cohort Inclusion Criteria: - all adults (>18 years of age) that underwent surgical intervention on the proximal aorta in Scotland between 2008 and 2021. Exclusion Criteria: - Isolated surgery on the descending thoracic aorta Non-surgical cohort Inclusion Criteria: - all adult patients (>18 years of age) with a radiological, genetic or post-mortem diagnosis of thoracic aortic disease

Study Design


Intervention

Procedure:
Surgery on the proximal aorta (aortic root +/- ascending aorta)
Surgery involving replacing, repairing or reinforcing the proximal aorta (root and ascending aorta)
Other:
Patients diagnosed with thoracic aortopathy but not operated upon
Radiological size criteria or Genetic mutations associated with aortopathies

Locations

Country Name City State
n/a

Sponsors (5)

Lead Sponsor Collaborator
Golden Jubilee National Hospital Aberdeen Royal Infirmary, Network for Inherited Cardiac Conditions Scotland, Royal Infirmary of Edinburgh, University of Glasgow

Outcome

Type Measure Description Time frame Safety issue
Primary Early survival following surgery of the proximal aorta In-hospital or 30 days survival following surgery of the proximal aorta In-hospital or 30 days (whichever is longer)
Primary Late survival following surgery of the proximal aorta Long-term survival following surgery of the proximal aorta 5 years or latest available follow-up (whichever is longer)
Primary Patient demographics and geographic distribution of thoracic aortopathy within the Scottish population Identify the demographics (age, gender, relevant risk factors) and geographic distribution (area codes) of patients diagnosed with thoracic aortopathy within the Scottish population Cross-sectional analysis (2011-2021)
Secondary Cardiovascular reintervention Reinterventions (surgical/endovascular) related to the aortic implant or unoperated aorta Reintervention on Aortic valve (native or prosthesis) 1 year or latest available follow-up (whichever is longer)
Secondary Specified adverse events following surgery episodes of endocarditis, structural valve degeneration, thromboembolism, cerebral vascular accident, anticoagulant-related bleeding 1 year or latest available follow-up (whichever is longer)
Secondary Left ventricular ejection fraction (LVEF) following surgery Long-term left ventricular ejection fraction (>50% - good, 31-50% - moderate, 21-30% - poor, 20% or less -very poor) as measured by echocardiography or cardiac MRI after surgery 1 year or latest available follow-up (whichever is longer)
Secondary Aortic valve mean gradient and degree of regurgitation following surgery Long-term aortic valve function as assessed by mean gradient (mmHg) and degree of regurgitation (mild/moderate/severe) in operated patients assessed by echocardiography or cardiac MRI 1 year or latest available follow-up (whichever is longer)
Secondary Genotypes and phenotypes prevalent in the Scottish population Identify genotypes and phenotypes in the Scottish population and assess their prevalence Previous 5 years
See also
  Status Clinical Trial Phase
Completed NCT05582967 - The DAShED (Diagnosis of Aortic Syndrome in the ED) Study
Terminated NCT04116684 - Digital Home Blood Pressure Monitoring in Type B Aortic Dissection Patients N/A
Completed NCT02086136 - Aortic Dissection Detection Risk Score Plus D-dimer in Suspected Acute Aortic Dissection
Recruiting NCT02201589 - Feasibility of Endovascular Repair Of Ascending Aortic Pathologies N/A
Recruiting NCT03948555 - Magnetic Resonance Imaging (MRI) for Aortic Dissection to Visualise Inflammation
Enrolling by invitation NCT05912608 - Optimal Strategy for Repair of Type A Acute Aortic Dissection
Recruiting NCT03707743 - Registry of Patients With Acute/Subacute Type B Aortic Dissection Treated by Means of the STABILISE Technique (STABILISE)
Enrolling by invitation NCT00583817 - Endovascular Treatment of Thoracic Aortic Disease N/A
Recruiting NCT05073991 - Incidence of Mortality and Complications After Lung Surgery, Open Thoracic Aortic Repair, TEVAR, EVAR.
Not yet recruiting NCT02523300 - Glucocorticoid on the Prognosis of TEVAR N/A
Completed NCT01197651 - Aortic-Stent-Register N/A
Recruiting NCT04471909 - NEXUS Aortic Arch Clinical Study to Evaluate Safety and Effectiveness N/A
Not yet recruiting NCT06044259 - Study Comparing Hemiarch Replacement and Hemiarch Plus Stent Implantation in Acute Aortic Dissection N/A
Completed NCT05039814 - Prediction of Postoperative Acute Kidney Injury in Patients With Acute Type A Aortic Dissection Using Cystatin C
Recruiting NCT03780738 - A Validation Study of The Relationship Between ALDH2 and Aortic Dissection
Completed NCT03647566 - 18F Sodium Fluoride PET/CT in Acute Aortic Syndrome
Enrolling by invitation NCT05800743 - Evaluation of the GORE® Ascending Stent Graft N/A
Recruiting NCT03347812 - Clinical Study for Evaluating the Safety and Efficacy of Total Endovascular Aortic Arch Repair N/A
Completed NCT05044494 - Surgery for Delay-recognized or Defer-operated Type A Aortic Dissection
Terminated NCT02958098 - My Research Legacy Pilot Study