Heart Diseases
Conditions
Keywords
Microcirculation, Cardiac Surgery
Brief summary
The aim of the proposed study is to evaluate microcirculatory alterations in patients undergoing open heart surgery under extracorporeal circulation. Positive clinical results evidenced with goal-directed perfusion and cerebral oximetry monitoring could be attributed to preserved microcirculation at tissue level.
Detailed description
The aim of the proposed study is to evaluate microcirculatory alterations in patients undergoing open heart surgery under extracorporeal circulation. Microcirculatory changes during cardiac surgery have been investigated mainly during coronary procedures using the conventional extracorporeal circulation. There is no single study in the literature investigating microcirculatory alterations using a perioperative strategy of physiologic perfusion. Positive clinical results evidenced with goal-directed perfusion and cerebral oximetry monitoring could be attributed to preserved microcirculation at tissue level. All patients will follow the same anaesthetic and perfusion protocol. The protocol for the evaluation of microcirculation will be based on: * Cerebral near-infrared spectroscopy (rScO2) measurements (INVOS, Covidien-Medtronic Inc.). * NIRS-Based Cerebral Autoregulation Monitoring: Analog arterial blood pressure signals will be digitized and then processed with the digital NIRS signals using a personal computer and a special ICM software (University of Cambridge, Cambridge, UK). Monitoring cerebral autoregulation ensures adequate renal perfusion. Hence, brain can be used not just as a target but also as an index organ indicating adequacy of perfusion. * Somatic near-infrared spectroscopy (rSsO2) measurements (INVOS, Covidien-Medtronic Inc.). * Sublingual mucosal microcirculation measurements during surgery using side dark field (SDF) imaging (MicroScan, Microvision Medical, Amsterdam, The Netherlands). All measurements will be performed at the following time points: T0: after induction of anaesthesia T1: after initiation of cardiopulmonary bypass T2: 10 minutes after cross- clamping the aorta T3: 10 minutes before removing the aortic cross-clamp T4: after weaning from extracorporeal circulation
Interventions
DEVICENIRS monitoring
Cerebral and somatic near-infrared spectroscopy (rScO2) measurements
DEVICECox monitoring
Cerebral autoregulation monitoring
DEVICESublingual microscopy
Sublingual mucosal microcirculation measurements during surgery using side dark field (SDF) imaging
Sponsors
Medtronic - MITG
AHEPA University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Patients undergoing open heart surgery with minimal invasive extracorporeal circulation (MiECC) according to accepted indications
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* patients aged \> 18 and \< 85 years with coronary artery disease and/or aortic valve disease undergoing open heart surgery with accepted indications
Exclusion criteria
* patients undergoing emergency surgery * patients in preoperative cardiogenic shock with evidence of tissue malperfusion * patients \> 85 years of age * patients with severe peripheral vascular disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of microcirculation | During surgery, from induction of anesthesia to weaning of extracorporeal circulation | Correlation of NIRS values with tissue microvascular activity |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global perfusion | During surgery, from induction of anesthesia to weaning of extracorporeal circulation | Global perfusion using cerebral NIRS during extracorporeal circulation |
| Cerebral autoregulation | During surgery, from induction of anesthesia to weaning of extracorporeal circulation | Calculation of cerebral oximetry index (COx) |
| Goal-directed perfusion | During surgery, from induction of anesthesia to weaning of extracorporeal circulation | Correlation of goal-directed perfusion with microvascular capillary density during extracorporeal circulation |
| Somatic perfusion | During surgery, from induction of anesthesia to weaning of extracorporeal circulation | Peripheral tissue oxygenation as measured with somatic NIRS |
Countries
Greece
Outcome results
None listed