Assessment Of Right Ventricular Function In Patients Undergoing Coronary Artery Bypass Graft In Assiut University

Assessment Of Right Ventricular Function In Patients Undergoing Coronary Artery Bypass Graft In Assiut University

Study Overview

• Status: Unknown
• Conditions: CORONARY ARTERY BYPASS
• Intervention / Treatment: Diagnostic test: 2D Echocardiography and 3D Echocardiography

Detailed Description

Right ventricular (RV) dysfunction is a major risk factor in coronary artery disease (CAD) and patient undergoing revascularization with this combination , incidence of RV dysfunction is reported in about 20% cases of CAD.

RV dysfunction is a possible cause of cardiac failure after cardiac surgery and has a high mortality rate.

RV dysfunction is a recognized cause of hypotension early after coronary artery bypass graft surgery (CABG)

A decrease in RV function is an event known to occur after CABG. Right ventricular dysfunction can be seen during and immediately after cardiac surgery. Although the mechanism of this phenomenon is not well understood, cardiopulmonary bypass, perioperative myocardial ischemia, intraoperative myocardial damage, cardioplegia, and pericardial disruption or adhesion have been suggested as probable causes.

Major reasons for complications of cardiac surgery are the need for hypothermic cardiac arrest, aortic cross clamping, and exposure to a cardiopulmonary bypass circuit.

It has been postulated that avoidance of these factors by performing off-pump coronary artery bypass (OPCAB) surgery might reduce perioperative morbidity and improve outcome.

Recently, the portion of coronary artery bypass grafting on the beating heart without the use of cardiopulmonary bypass (CPB) has been expanded in cardiac surgery as a result of awareness of the damaging effect of CPB

Whether OPCAB surgery can fulfill these expectations, or to which degree, is yet unclear.

A few studies on hemodynamic alternations associated with OPCAB reported that reduced functions of both ventricles during coronary artery anastomosis are the main mechanism of hemodynamic derangements and especially, impaired diastolic function of the right ventricle (RV) plays an important role

However, clinical studies evaluating the change in RV function in patients with ischemic heart disease are very rare. It is reported that the major cause of hemodynamic changes during OPCAB was disturbed diastolic filling of the RV through the measurement of chamber pressures or monitoring of echocardiography.

There was no significant change in the RVEF and cardiac index during anastomosis of the left anterior descending artery and right coronary artery. However, the significantly reduced RVEF accompanied by an increase in RV afterload and decrease in the CO was observed during anastomosis of the obtuse marginal (OM) artery. RV volumes did not significantly change during anastomoses, though the right atrial pressure increased during anastomoses of all coronary arteries. The displacement of beating heart for positioning during anastomosis of the graft to OM artery caused significant derangement of RV function and decrease in CO.

• Study Type: Observational
• Enrollment (Anticipated): 150

Contacts and Locations

Study Locations

• Egypt
  • Assiut, Egypt, 17642
    • Assiut University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

This study will include patients will undergo elective CABG of different ages from cardiology department, Assiut University Hospital

Description

1. Inclusion criteria:

   • Patients will undergo elective CABG in Assiut university hospital

2. Exclusion criteria:

   • Poor echo window.
   • Refusal of the patient
   • Patients with prior RV dysfunction.
   • Patients with LV dysfunction (EF:<40%).

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of effects of CABG on right ventricular function	assessment of right ventricular function in patients undergoing CABG using 2D echocardiography and 3D echocardiography	6 months

Collaborators and Investigators

• Sponsor: Assiut University
• Investigators: Study Chair: Salah Atta, Professor; Study Chair: Salma Taha, lecturer

Publications and helpful links

General Publications

• Roshanali F, Yousefnia MA, Mandegar MH, Rayatzadeh H, Alinejad S. Decreased right ventricular function after coronary artery bypass grafting. Tex Heart Inst J. 2008;35(3):250-5.

Study record dates

Study Major Dates

• Study Start (Anticipated): September 10, 2017
• Primary Completion (Anticipated): September 30, 2018
• Study Completion (Anticipated): September 30, 2018

Study Registration Dates

• First Submitted: August 27, 2017
• First Submitted That Met QC Criteria: September 5, 2017
• First Posted (Actual): September 7, 2017

Study Record Updates

• Last Update Posted (Actual): September 7, 2017
• Last Update Submitted That Met QC Criteria: September 5, 2017
• Last Verified: September 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: 17100309

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No