None listed
Conditions
Brief summary
The aim of this project is to investigate whether or not using the right internal mammary artery (rather than the ascending aorta) as a source of blood inflow for coronary artery bypass graft surgery (CABG) results in superior long term graft patency. CABG has been shown to be the most durable method of myocardial revascularisation. Efforts to further extend the long-term benefits of CABG have mainly focussed primarily on improving graft patency rates by using arterial grafts. Less attention has been paid to graft haemodynamics, particularly the source of graft inflow, and the role that this may play in prolonging graft patency. We know that high wall sheer stress leads to graft failure and we believe that gentler mammary artery inflow may encourage improved graft harm-dynamics and therefore patency. We plan to randomise patients undergoing CABG to standard practice (which involves using the ascending aorta as inflow) or to a composite graft group (using the right internal mammary artery as inflow) in order to assess whether or not graft inflow affects patency.
Interventions
A cardiac surgeon will perform 'on-pump' coronary artery bypass surgery for all patients, this procedure takes approximately 3-4.5 hours, . Patients undergoing isolated coronary artery bypass surgery are suitable. All patients included in the study (both intervention and control) will receive a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft. The intervention group will receive conduit inflow from the right internal mammary artery (RIMA) as an extension/comp
A cardiac surgeon will perform 'on-pump' coronary artery bypass surgery for all patients, this procedure takes approximately 3-4.5 hours, . Patients undergoing isolated coronary artery bypass surgery are suitable. All patients included in the study (both intervention and control) will receive a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft. The intervention group will receive conduit inflow from the right internal mammary artery (RIMA) as an extension/composite graft to supply the largest "non-LAD" coronary territory. The procedure for patients in the intervention arm is expected to take approximately 15 minutes longer to permit harvesting a short segment of the right internal mammary artery (RIMA). Adherence to protocol intervention will be determined through contemporaneous data entry by the treating team with control-checking by independent researcher audit of surgeons operative notes.
Sponsors
Dr Levi Bassin
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult patients undergoing isolated coronary artery bypass surgery
Exclusion criteria
< 40 years old Non-English language speaking Unable to consent for medical procedures unassisted Contra-indication to either arm of the Protocol (e.g. porcelain aorta, previous saphenous vein ablation, mediastinal radiation etc) Previous cardiac or thoracic surgery
Outcome results
None listed