Stroke Clinical Trial
Official title:
Carbon Dioxide Surgical Field Flooding and Aortic No-touch Off-pump Coronary Artery Bypass Grafting to Reduce Neurological Injuries After Surgical Coronary Revascularization (CANON): a Randomised, Controlled, Investigator and Patient Blinded Single Center Superiority Trial With Three Parallel Arms.
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.
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