Aortic Valve Stenosis, Coronary Artery Disease, Extracorporeal Circulation; Complications
Conditions
Keywords
Cardiopulmonary bypass, Extracorporeal circulation, Minimal invasive extracorporeal circulation, Coronary artery bypass grafting, Aortic valve replacement
Brief summary
MiECS is one of the largest multicentre randomised controlled trials on extracorporeal circulation conducted under the auspices of Minimal Invasive Extracorporeal Technologies International Society (MiECTiS). It is designed to ultimately address the emerging effectiveness of MiECC systems in the light of modern perfusion practice worldwide. The primary hypothesis is that MiECC, as compared to conventional CPB (cCPB), reduces the proportion of patients experiencing serious perfusion-related postoperative morbidity after cardiac surgery. The study will be led by the Clinical Research Unit of the Special Unit for Biomedical Research and Education (SUBRE), Aristotle University of Thessaloniki School of Medicine in Greece (AUSoM) with Chief Investigator Professor Kyriakos Anastasiadis, who is a key-opinion-leader in the field of MiECC, founder and Executive Board of MiECTiS.
Detailed description
Despite a fall in mortality rates over the past decade, patients having cardiac surgery continue to experience serious postoperative complications. The risk of serious and relatively common surgical complications is often a consequence of stopping the heart during the operation, using the heart and lung machine (conventional cardiopulmonary bypass; cCPB), and restarting and reperfusing the heart at the end of the operation. Although several strategies have been developed to reduce such complications, they still occur and can be life threatening; they also increase the length of time a patient spends in the hospital. Miniaturised heart lung machines (minimally invasive extracorporeal circulation; MiECC) have been developed with the aim of reducing the number of postoperative complications arising from using cCPB. Because of the variety of miniaturised systems that have been evaluated, the different types of patients and outcomes investigated, and the poor quality of previous studies, the effectiveness of MiECC in reducing postoperative complications has not been established and most hospitals continue to use cCPB. Our primary hypothesis is that, compared to cCPB, using a MiECC system during cardiac surgery reduces the proportion of patients having one of several serious postoperative complications (death, myocardial infarction, stroke, acute kidney injury, reintubation, tracheostomy, mechanical ventilation for more than 48 hours, or reoperation) up to 30 days after surgery. In addition, the investigators hypothesise that MiECC reduces the amount of blood products transfused, time to discharge from the cardiac intensive care unit and hospital and the health care resources used during the hospital stay. Study investigators propose to carry out a large, multicentre randomised controlled trial in 10 to 15 cardiac surgery centres worldwide. Patients will be eligible if they are having coronary artery bypass surgery, aortic valve replace or both using a heart lung machine without circulatory arrest. Centres may recruit patients having all, or a subset of, operation types. It is expected that 20 % to 23% of patients will experience one or more of the serious complications (the primary outcome). In order to be able confidently to detect a 30% relative reduction in the risk of this outcome, the investigators plan to recruit 1,300 participants across all sites.
Interventions
DEVICEMinimal Invasive Extracorporeal Circulation
Cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC).
Cardiac surgery with conventional cardiopulmonary bypass (cCPB).
Sponsors
Aristotle University Of Thessaloniki
Minimal Invasive Extracorporeal Technologies International Society (MiECTiS)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or both procedures CABG+AVR using extracorporeal circulation without circulatory arrest will be randomised (1:1 ratio) to having surgery using Minimal Invasive Extracorporeal Circulation (MiECC) or conventional cardiopulmonary bypass (cCPB).
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* All patients undergoing any elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or CABG+AVR surgery using extracorporeal circulation without circulatory arrest.
Exclusion criteria
* Requirement for emergency or salvage operation. * Requirement for major aortic surgery (e.g. aortic root replacement). * Contraindication or objection (e.g. Jehovah's Witnesses) to transfusion of blood products. * Congenital or acquired platelet, red cell or clotting disorders (patients with iron deficient anaemia will not be excluded). * Inability to give informed consent for the study (e.g. learning or language difficulties).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite outcome of postoperative serious adverse events | 30 days after randomization following the index admission | Incidence of: death, postoperative myocardial infarction according to Fourth Universal Definition of myocardial infarction, stroke, all stage acute kidney injury, as defined with AKI Network criteria, Re-intubation, need for mechanical ventilation for \> 48 hours, including multiple episodes when separated by more than 12 hours, reoperation and septicaemia confirmed by positive blood culture. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All-cause mortality | 30 days after randomization following the index admission | All-cause mortality |
| New-onset postoperative atrial fibrillation | Through initial hospital admission from surgery to initial discharge from hospital, an average of 1 week. | Incidence of new-onset postoperative atrial fibrillation |
| Rate of red blood cells transfusion | 30 days after randomization following the index admission | Units of red blood cells transfused |
| Rate of platelet transfusion | 30 days after randomization following the index admission | Units of platelets transfused |
| Rate of fresh frozen plasma transfusion | 30 days after randomization following the index admission | Units of fresh frozen plasma transfused |
| Rate of cryoprecipitate transfusion | 30 days after randomization following the index admission | Units of cryoprecipitate transfused |
| Activated Factor VII administration | 30 days after randomization following the index admission | Incidence of activated factor VII administration |
| Fibrinogen administration | 30 days after randomization following the index admission | Incidence of fibrinogen administration |
| Prothrombin complex concentrate administration | 30 days after randomization following the index admission | Incidence of prothrombin complex concentrate administration |
| Time to discharge from cardiac ICU | Through initial hospital admission from surgery to initial discharge from hospital, an average of 1 week. | Time to discharge from cardiac ICU |
| Time to discharge from hospital | Through initial hospital admission from surgery to initial discharge from hospital, an average of 1 week. | Time to discharge from hospital |
| Delirium | Up to 5 days postoperatively | Incidence of postoperative delirium |
| Health-Related Quality of Life (HRQoL) | 90 days after randomization | HRQoL assessed with EQ-5D questionnaire |
Countries
Canada, Germany, Greece, Italy, Turkey (Türkiye), United Kingdom
Contacts
CONTACTGeorgios Papazisis, Assoc. Prof.
STUDY_CHAIRKyriakos Anastasiadis, Professor
Aristotle University Of Thessaloniki
STUDY_DIRECTORPolychronis Antonitsis, Assoc. Prof.
Aristotle University Of Thessaloniki
Outcome results
None listed