- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02390713
Pneumatic Reversible Portal Vein Diameter Modulation After Major Hepatectomy (MODHEP1)
Pneumatic Reversible Portal Vein Diameter Modulation After Major Hepatectomy in Non Cirrhotic Patient
Study Overview
Detailed Description
Preserving liver function is vital, especially after hepatectomy, the main curative treatment of liver tumor. An hepatectomy that preserved a remnant liver volume < 0.5% of the body weight is associated with a very high risk of post-operative liver failure. In such situation, liver volume is not sufficient to support local hemodynamic consequences of the hepatectomy that is responsible of intrahepatic endothelial cell injury that impaired liver function and regeneration. To date, preoperative vein embolization (PVE) associated or not to liver transection (ALPSS procedure) that increased future remnant liver from 20% to 90% is the only method to prevent this complication. Even this preparation is necessary for the moment, PVE increased cancer cell proliferation and is associated with lower recurrence free survival than without PVE. Despite a potential PVE, POLF occurred in 5% to 7% after major hepatectomy and stayed the first cause of death after hepatectomy. It has been demonstrated that portal pressure superior to 20 mm Hg and/or porto-caval gradient superior to 12 mm Hg at the end of hepatectomy was associated to the occurrence of POLF. Aim to avoid this acute intra hepatic portal hypertension associated to major hepatectomy that is associated with an early liver endothelial cell injury, we had developed an silicon ring to dispose around the portal vein that contained an circular inflatable balloon to narrow precisely the portal vein lumen (MID-AVRTM).
Phase A: Tolerance and functionality of MID-AVR during surgery Each procedure will be filmed. Phase B: Tolerance and functionality of MID-AVR after surgery Each procedure will be filmed.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Contact
- Name: Eric VIBERT, MD, PhD
- Phone Number: +33 (0)6 60 64 96 97
- Email: eric.vibert@pbr.aphp.fr
Study Locations
-
-
-
Villejuif, France, 94
- Recruiting
- AP-HP, Paul Brousse Hospital, Centre Hepato-Biliaire
-
Contact:
- Laina N'DIAYE
- Phone Number: +33 (0)1 45 21 31 72
- Email: laina.ndiaye@bct.aphp.fr
-
Principal Investigator:
- Eric VIBERT, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- French resident affiliated to Social Insurance
- Major hepatectomy (Phase A)
- Major hepatectomy that preserved only one hepatic vein (Phase B)
- Remnant liver volume > 0.5% of the body weight
Exclusion Criteria:
- Age > 80 (Phase A) and Age > 70 (Phase B)
- Cirrhotic patient (F4)
- Repeat hepatectomy
- Patient who required a portal vein resection
- History of deep venous thrombosis
- History of portal thrombosis
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: MID-AVR
Tolerance and functionality of MID-AVR during surgery (Phase A) and after surgery (Phase B)
|
Phase A (4 patients): After laparotomy and dissection of hepatic pedicle, feasibility of MID-AVR positioning around the portal vein by hepato-biliary surgeon and visual evaluation of potential spatial conflict with hepatic artery and choledochal. Mid-AVR is removed at the end of surgery. Each procedure will be filmed. Phase B (12 patients): Mid-AVR is maintained at the end of surgery, and during 48 hours to evaluate the persistence of an hepatopetal portal flow without portal vein thrombosis upstream MID-AVR during the 48 hours after the liver surgery at bi-daily ultrasonography. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Success of MID-AVR positioning
Time Frame: intraoperative
|
Phase A: Feasibility of MID-AVR positioning around the portal vein by hepato-biliary surgeon and visual evaluation of potential spatial conflict with hepatic artery and choledochal.
Each procedure will be filmed.
|
intraoperative
|
Persistence of an hepatopetal portal flow at bi-daily ultrasonography
Time Frame: during the 48 hours after the liver surgery
|
Phase B: Persistence of an hepatopetal portal flow without portal vein thrombosis upstream MID-AVR
|
during the 48 hours after the liver surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Portal pressure measured upstream and downstream the MID-AVR
Time Frame: intraoperative
|
Phase A
|
intraoperative
|
Portal flow measured downstream the MID-AVR
Time Frame: intraoperative
|
Phase A
|
intraoperative
|
Liver perfusion assessed by intraoperative contrast enhanced ultrasonography
Time Frame: intraoperative
|
Phase A
|
intraoperative
|
Reliability of MID-AVR opening by balloon inflation and removal from the portal vein by smooth traction on the tube that is connected to MID-AVR.
Time Frame: intraoperative
|
Phase A Each procedure will be filmed.
|
intraoperative
|
Occurrence of POLF (Bilirubin > 50 µmol/L and PT < 50% )
Time Frame: at postoperative day 3
|
Phase B
|
at postoperative day 3
|
Occurrence of post-operative hemorrhage (decrease in haemoglobin that required red pack cell transfusion)
Time Frame: at postoperative day 3
|
Phase B
|
at postoperative day 3
|
Occurrence of Post-operative biliary fistulae (Bilirubin concentration in fluid drainage greater than 3 fold the plasmatic bilirubin rate)
Time Frame: at postoperative day 3
|
Phase B
|
at postoperative day 3
|
Reliability of MID-AVR opening by balloon inflation and percutaneously removal from the portal vein by smooth traction on the tube that is connected to MID-AVR.
Time Frame: at postoperative day 3
|
Phase B Removal will be done at the operating room under neurolept analgesia and local anesthesia under radiological control.
Each procedure will be filmed.
|
at postoperative day 3
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Eric VIBERT, MD, PhD, AP-HP, Paul Brousse Hospital, Centre Hepato-Biliaire, Villejuif, France
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- P131002
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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