CABG, Myocardial Viability
Conditions
Keywords
CABG, Cardiac magnetic resonance imaging, Coronary artery disease, cardioplegia
Brief summary
Myocardial protection during surgical myocardial revascularization is crucial for reducing perioperative myocardial injury and improving postoperative outcomes. Blood cardioplegia represents the standard method in many centers, while del Nido cardioplegia, originally developed for the pediatric population, is increasingly being used in adult patients as well.
Detailed description
Previous studies have demonstrated reliable myocardial protection with Del Nido cardioplegia; however, most comparisons with conventional blood cardioplegia are based on biochemical markers (troponin, CK-MB) and echocardiography. Cardiac magnetic resonance imaging (CMR) enables noninvasive, highly sensitive assessment of left ventricular function as well as myocardial viability, edema, and fibrosis, and represents the gold standard for the evaluation of ventricular volumes and ejection fraction. To date, this imaging modality has not been used as a method for comparing different myocardial protection strategies in the context of various cardioplegic solutions. The study will include patients with isolated coronary artery disease who are scheduled for surgical myocardial revascularization. Exclusion criteria will include the need for concomitant valve, aortic, or other cardiac surgery, as well as patients planned for myocardial revascularization without the use of cardiopulmonary bypass. Additionally, patients with contraindications to CMR will be excluded from the study.
Interventions
DRUGDel Nido Cardioplegia Solution for myocardial protection
CABG patients receiving Del Nido cardioplegia as the myocardial protection strategy
DRUGBlood Cardioplegia Solution for myocardial protection
Patients will receive Blood Cardioplegia Solution for myocardial protection
Sponsors
Klinički Bolnički Centar Zagreb
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Eligibility Criteria: 1\. Patients with multivessel coronary artery disease scheduled for elective coronary artery bypass grafting
Exclusion criteria
1. Left ventricular ejection fraction \<30% 2. Associated cardiac procedures 3. Off-pump coronary artery bypass grafting 4. Contraindications for MRI 5. Inability to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial Viability Assessed by Magnetic Resonance Imaging | Patients will undergo the initial cardiac MRI scan before surgery. The follow-up MRI will be scheduled approximately 4 weeks after surgical revascularization. | Myocardial Viability Assessed by Magnetic Resonance Imaging |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Major Adverse Cardiac and Cerebrovascular Events | MACCE will be adjudicated at 30 days and 6 months. | The secondary outcome will be a composite of mortality, periprocedural myocardial infarction, stroke, and cardiac rehospitalization |
Countries
Croatia
Contacts
CONTACTHrvoje Gasparovic, MD, PhD
PRINCIPAL_INVESTIGATORHrvoje Gasparovic
Clinical Hospital Centre Zagreb
Outcome results
None listed