Assessment Of Right Ventricular Function In Patients Undergoing Coronary Artery Bypass Graft In Assiut University

CORONARY ARTERY BYPASS Clinical Trial

Official title:

Assessment Of Right Ventricular Function In Patients Undergoing Coronary Artery Bypass Graft In Assiut University

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT03275220
• Other study ID #: 17100309
• Status: Not yet recruiting
• Phase: N/A
• First received: August 27, 2017
• Last updated: September 5, 2017
• Start date: September 10, 2017
• Est. completion date: September 30, 2018

Study information

• Verified date: September 2017
• Source: Assiut University
• Contact: Maria Refaat, master
• Phone: 01120108960
• Email: Merofouad307[@]yahoo.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Assessment Of Right Ventricular Function In Patients Undergoing Coronary Artery Bypass Graft In Assiut University

Description:

Right ventricular (RV) dysfunction is a major risk factor in coronary artery disease (CAD) and patient undergoing revascularization with this combination , incidence of RV dysfunction is reported in about 20% cases of CAD.

RV dysfunction is a possible cause of cardiac failure after cardiac surgery and has a high mortality rate.

RV dysfunction is a recognized cause of hypotension early after coronary artery bypass graft surgery (CABG)

A decrease in RV function is an event known to occur after CABG. Right ventricular dysfunction can be seen during and immediately after cardiac surgery. Although the mechanism of this phenomenon is not well understood, cardiopulmonary bypass, perioperative myocardial ischemia, intraoperative myocardial damage, cardioplegia, and pericardial disruption or adhesion have been suggested as probable causes.

Major reasons for complications of cardiac surgery are the need for hypothermic cardiac arrest, aortic cross clamping, and exposure to a cardiopulmonary bypass circuit.

It has been postulated that avoidance of these factors by performing off-pump coronary artery bypass (OPCAB) surgery might reduce perioperative morbidity and improve outcome.

Recently, the portion of coronary artery bypass grafting on the beating heart without the use of cardiopulmonary bypass (CPB) has been expanded in cardiac surgery as a result of awareness of the damaging effect of CPB

Whether OPCAB surgery can fulfill these expectations, or to which degree, is yet unclear.

A few studies on hemodynamic alternations associated with OPCAB reported that reduced functions of both ventricles during coronary artery anastomosis are the main mechanism of hemodynamic derangements and especially, impaired diastolic function of the right ventricle (RV) plays an important role

However, clinical studies evaluating the change in RV function in patients with ischemic heart disease are very rare. It is reported that the major cause of hemodynamic changes during OPCAB was disturbed diastolic filling of the RV through the measurement of chamber pressures or monitoring of echocardiography.

There was no significant change in the RVEF and cardiac index during anastomosis of the left anterior descending artery and right coronary artery. However, the significantly reduced RVEF accompanied by an increase in RV afterload and decrease in the CO was observed during anastomosis of the obtuse marginal (OM) artery. RV volumes did not significantly change during anastomoses, though the right atrial pressure increased during anastomoses of all coronary arteries. The displacement of beating heart for positioning during anastomosis of the graft to OM artery caused significant derangement of RV function and decrease in CO.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 150
• Est. completion date: September 30, 2018
• Est. primary completion date: September 30, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

1. Inclusion criteria:

• Patients will undergo elective CABG in Assiut university hospital

2. Exclusion criteria:

• Poor echo window.

• Refusal of the patient

• Patients with prior RV dysfunction.

• Patients with LV dysfunction (EF:<40%).

Related Conditions & MeSH terms

• CORONARY ARTERY BYPASS

Intervention

Diagnostic Test:
• 2D Echocardiography and 3D Echocardiography
Imaging of right ventricle by 2d echocardiography and 3D echocardiography to assess right ventricular function accurately

Locations

Country	Name	City	State
Egypt	Assiut university	Assiut

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

Country where clinical trial is conducted

Egypt, 

References & Publications (1)

Roshanali F, Yousefnia MA, Mandegar MH, Rayatzadeh H, Alinejad S. Decreased right ventricular function after coronary artery bypass grafting. Tex Heart Inst J. 2008;35(3):250-5. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Assessment of effects of CABG on right ventricular function	assessment of right ventricular function in patients undergoing CABG using 2D echocardiography and 3D echocardiography	6 months