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Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

BACKGROUND: In severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As...

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Autores principales: Drouin, Ariane, Noiseux, Nicolas, Chartrand-Lefebvre, Carl, Soulez, Gilles, Mansour, Samer, Tremblay, Jan-Alexis, Basile, Fadi, Prieto, Ignacio, Stevens, Louis-Mathieu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766263/
https://www.ncbi.nlm.nih.gov/pubmed/23971858
http://dx.doi.org/10.1186/1745-6215-14-270
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author Drouin, Ariane
Noiseux, Nicolas
Chartrand-Lefebvre, Carl
Soulez, Gilles
Mansour, Samer
Tremblay, Jan-Alexis
Basile, Fadi
Prieto, Ignacio
Stevens, Louis-Mathieu
author_facet Drouin, Ariane
Noiseux, Nicolas
Chartrand-Lefebvre, Carl
Soulez, Gilles
Mansour, Samer
Tremblay, Jan-Alexis
Basile, Fadi
Prieto, Ignacio
Stevens, Louis-Mathieu
author_sort Drouin, Ariane
collection PubMed
description BACKGROUND: In severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk). METHODS/DESIGN: Between July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization. DISCUSSION: This non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01585285.
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spelling pubmed-37662632013-09-08 Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial Drouin, Ariane Noiseux, Nicolas Chartrand-Lefebvre, Carl Soulez, Gilles Mansour, Samer Tremblay, Jan-Alexis Basile, Fadi Prieto, Ignacio Stevens, Louis-Mathieu Trials Study Protocol BACKGROUND: In severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk). METHODS/DESIGN: Between July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization. DISCUSSION: This non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01585285. BioMed Central 2013-08-26 /pmc/articles/PMC3766263/ /pubmed/23971858 http://dx.doi.org/10.1186/1745-6215-14-270 Text en Copyright © 2013 Drouin et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Study Protocol
Drouin, Ariane
Noiseux, Nicolas
Chartrand-Lefebvre, Carl
Soulez, Gilles
Mansour, Samer
Tremblay, Jan-Alexis
Basile, Fadi
Prieto, Ignacio
Stevens, Louis-Mathieu
Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title_full Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title_fullStr Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title_full_unstemmed Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title_short Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
title_sort composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766263/
https://www.ncbi.nlm.nih.gov/pubmed/23971858
http://dx.doi.org/10.1186/1745-6215-14-270
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