Coronary Artery Disease, Valvular Heart Disease
Conditions
Keywords
Coronary artery disease, Valvular heart disease, Fractional flow reserve, Coronary artery bypass surgery, Coronary graft failure or patency
Brief summary
The purpose of this study is to determine whether, in patients undergoing elective valvular heart surgery, revascularization of concomitant coronary artery disease (CAD) guided by FFR (Fractional flow reserve) would be superior to standard angiography-guided-revascularization approach on major efficacy and safety outcomes
Detailed description
The SAVE-IT trial is a multicenter, international, randomized, controlled, superiority trial. Patients scheduled to undergo elective valvular heart surgery will be screened for presence of concomitant coronary artery disease (CAD) by invasive coronary angiography. Patients with a stenosis \> 50% in at least one epicardial vessel (excluding left main) considered suitable for surgical revascularization will be randomized to FFR guided- or standard angiography-guided surgical revascularization. A proportion of patients with no concomitant CAD will be followed in a parallel registry Baseline clinical, laboratory, electrocardiographic and echocardiographic data will be obtained. Coronary anatomy severity will be assessed by quantitative coronary angiography (QCA) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (Syntax) score. Surgical risk will be assessed by Euroscore. Patients randomized to FFR-guided arm will have functional severity of the angiographic stenosis assessed by a St. Jude Medical coronary pressure wire measurement under hyperemic conditions using intravenous or intracoronary adenosine administration. If the FFR is ≤0.8 then a graft will be placed distal to the coronary stenosis. If the FFR is \>0.8 no grafting will be performed to the epicardial vessel containing the stenosis. Patients will receive cardiac surgery no later than 8 weeks after randomization. Peri-operative data will be collected. Clinical follow-up data will be collected at 1, 6 and 12 month after surgery. Graft patency at 12 months will be assessed by cardiac computed angiography (CCTA) for all patients who received at least one graft, except if an invasive coronary angiography has been performed in the preceding 3 months based on clinical grounds.
Interventions
PROCEDUREFFR-guided surgical revascularization
PROCEDUREAngio-guided surgical revascularization
Sponsors
Abbott Medical Devices
Portuguese Society of Cardiology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Severe heart valve disease with indication for an elective cardiac with a St. Jude Medical Heart Valve * Concomitant significant CAD (at least one epicardial vessel with a stenosis\> 50%) * Willing and able to provide informed written consent
Exclusion criteria
* Previous CABG * Angiographic significant lesion involving left main lesion (patient is still eligible if right coronary artery is candidate for FFR measurement and surgical revascularization) * All lesions in extremely tortuous or calcified coronary vessels * Recent myocardial infarction (\< 30 days) * Cardiogenic shock or clinical instability (i.e. NYHA 4, uncontrolled arrhythmias, unexplained hypotension severe bradycardia or any other medical condition considered as a sign of instability by the assisting physician) * Severe left ventricular dysfunction (EF \< 35%) * Pregnant or are planning to become pregnant during the duration of the investigation * Chronic renal dysfunction as defined as estimated glomerular filtration rate \< 60 ml/min * Life expectancy \< 12 months * Currently participating in any other clinical investigation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MACCE | 12 months | Composite endpoint of death, nonfatal myocardial infarction, unplanned revascularization and stroke at 12 months. Subjects who die or are lost to follow up before 1 year will be censored at their last recorded activity. |
| Graft failure | 12 months | Graft patency as assessed by CCTA scheduled at 12 months. Graft status can also be assessed by invasive coronary angiography if clinically indicated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MACCE | 1 month | death, nonfatal myocardial infarction, unplanned revascularization and stroke |
Other
| Measure | Time frame | Description |
|---|---|---|
| Total circulatory bypass time | expected maximum of 300 minutes | measured in minutes |
| Total cross-clamp time | expected maximum of 300 minutes | measured in minutes |
| Acute renal injury | to post-operative day 4 | Percentage decline in glomerular filtration rate at post-operative day 4 as compared to pre-operative glomerular filtration rate |
| Blood transfusion | participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | Number of units of red blood cells transfused. |
| Post operative atrial fibrillation rate | Participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | Occurrence of any documented episode of symptomatic or asymptomatic episode of atrial fibrillation |
| Time to inotropic weaning | participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | Total time spent with inotropic support. Recurrent use will be quantified |
| Use of intra-aortic balloon pump (IABP) | participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | Number of patients requiring mechanical hemodynamic support with IABP |
| Anginal status | 12 months | Symptomatic status as defined canadian cardiac society (CCS) anginal status score |
| Heart failure symptoms | 12 months | Symptomatic status as defined per New York Heart Association (NYHA) score |
| Duration of mechanical ventilation | participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | Total duration of mechanical ventilatory support. Repeated intubation will be included |
| Post operative ICU stay | participants will be followed for the duration of hospital stay, an expected maximum of 4 weeks | From cardiac surgery end to transfer to intermediate care unit or ward. Measured in hours. |
| Hospitalization period | expected average of ten days | From cardiac surgery to hospital discharge. Measured in days.From date of cardiac surgery until the date of first hospital discharge assessed up to 8 weeks |
Countries
Portugal
Contacts
Primary ContactRuben Ramos, MD
Backup ContactMafalda Selas, RN
Outcome results
None listed