Use of the Cardioprotectant Dexrazoxane During Congenital Heart Surgery
maanantai 2. elokuuta 2021 päivittänyt: Daniel Stromberg, University of Texas at Austin
Cardiopulmonary bypass and arrest of the heart during cardiac surgery are necessary to allow the surgeon to perform heart operations. However, these processes can cause injury to the heart which may worsen post-operative outcomes. In fact, the effects of these injuries may continue after surgery, and lead to a long-term decrease in heart function. Neonates and young infants are at particular risk for this occurrence.
While much research has been done in adults looking for medicines that might protect the heart during surgery, few studies have been conducted in neonates and young infants. The investigators are testing Dexrazoxane, which has proven to be cardio-protective in pediatric cancer patients, in the hope that it may lessen cardiac injury during and after congenital heart surgery, and thereby improve outcomes in the neonatal and young infant population.
In order to accomplish this, the investigators must first determine how Dexrazoxane can be safely administered to young children with congenital heart disease.
Tutkimuksen yleiskatsaus
Yksityiskohtainen kuvaus
Neonates and infants undergoing heart surgery with cardiopulmonary bypass and cardioplegic arrest experience both inflammation and myocardial ischemia-reperfusion [IR] injury. These processes provoke myocardial apoptosis and oxygen free radical formation which result in cardiac injury and dysfunction. Dexrazoxane [DRZ] is a derivative of EDTA that is approved for prevention of anthracycline-related cardiotoxicity. It provides cardioprotection through reduction of toxic reactive oxygen species [ROS], and suppression of apoptosis.
The investigators propose a 12-patient pilot to determine DRZ pharmacokinetics, and to collect additional safety data in the neonatal and infant population. Efficacy of cardioprotection will not be evaluated in this preliminary investigation, though the investigators will determine postoperative time to resolution of organ failure, development of low cardiac output syndrome, length of cardiac ICU and hospital stays, laboratory indices of myocardial injury and systemic inflammation, and echocardiographic cardiac dysfunction for safety purposes, and as a run-in to the larger, randomized, placebo controlled trial. Conducting this pilot could optimize team execution of the study protocol. In addition, results could further establish the safety of DRZ in the neonatal and infant populations.
Opintotyyppi
Interventio
Ilmoittautuminen (Odotettu)
12
Vaihe
- Vaihe 1
Yhteystiedot ja paikat
Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.
Opiskeluyhteys
- Nimi: Daniel Stromberg, MD
- Puhelinnumero: 512-324-3357
- Sähköposti: dstromberg@austin.utexas.edu
Tutki yhteystietojen varmuuskopiointi
- Nimi: Jacob Strelow, MPH
- Puhelinnumero: 757-268-2691
- Sähköposti: strelow.jacob@austin.utexas.edu
Opiskelupaikat
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-
Texas
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Austin, Texas, Yhdysvallat, 78723
- Rekrytointi
- Dell Children's Medical Center of Central Texas
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Osallistumiskriteerit
Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.
Kelpoisuusvaatimukset
Opintokelpoiset iät
1 sekunti - 1 vuosi (Lapsi)
Hyväksyy terveitä vapaaehtoisia
Ei
Sukupuolet, jotka voivat opiskella
Kaikki
Kuvaus
Inclusion Criteria:
- age ≤ 1 year
- open heart surgery requiring CPB and use of cardioplegia
- parent/guardian consent for study obtained
- surgery planned Monday-Friday
Exclusion Criteria:
- gestational age <36 weeks at time of enrollment
- known syndrome or genetic abnormality, except Trisomy 21
- single ventricle physiology
- concurrent enrollment in another research protocol
Opintosuunnitelma
Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei käytössä
- Inventiomalli: Yksittäinen ryhmätehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
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Kokeellinen: Dexrazoxane
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Twelve enrollees will be consecutively assigned to a dosing regimen of 400 mg/m2/dose.
The medication will be administered in the operating room 30 minutes prior to starting cardiopulmonary bypass (dose #1), prior to aortic cross clamp removal (dose #2), and on the morning after surgery in the cardiac intensive care unit (dose #3).
Muut nimet:
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Plasman huippupitoisuus (Cmax)
Aikaikkuna: 24 tuntia
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24 tuntia
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Area under the plasma concentration vs time curve (AUC)
Aikaikkuna: 24 hours
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24 hours
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Minimum plasma concentration (Cmin)
Aikaikkuna: 24 hours
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24 hours
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|
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Time to resolution of organ failure
Aikaikkuna: 14 days
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defined as hours to the point of being off invasive mechanical ventilation, without significant renal dysfunction [cystatin C within normal range for age, and UOP > 1 cc/kg/hr], and off significant inotropic support [defined as milrinone >0.3 mcg/kg/min, dopamine >3 mcg/kg/min, dobutamine >3 mcg/kg/min, any combination of these inotropes, or any epinephrine, norepinephrine, phenylephrine or vasopressin)] with a serum lactate <2 mmol/L.
One point will be awarded for each postoperative hour of continued organ dysfunction up to postoperative hour 336 (day 14).
A score of 360 will be assigned if organ failure is not resolved by postoperative day 14, or if the patient requires mechanical circulatory support or experiences mortality.
This variable has been chosen to allow for recognition of early drug effects, and those which might be delayed beyond the immediate postoperative period.
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14 days
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Myocardial Injury
Aikaikkuna: 7 days
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determined by elevated serum cardiac troponin
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7 days
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Oxidative Stress
Aikaikkuna: 3 days
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measured by lipoperoxidation (serum F2 isoprostane)
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3 days
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Inflammatory activation (IL-6 and IL-10)
Aikaikkuna: 3 days
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3 days
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Neurologic IR injury
Aikaikkuna: 3 days
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measured by serum activin A concentration
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3 days
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ICU Length of Stay
Aikaikkuna: 60 days
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60 days
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Hospital Length of Stay
Aikaikkuna: 60 days
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60 days
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Tei Index (via echocardiogram)
Aikaikkuna: 60 days
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the sum of the isovolumic contraction and relaxation times divided by the ejection time
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60 days
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Ventricular ejection fraction (via echocardiogram)
Aikaikkuna: 60 days
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the volumetric fraction of fluid ejected from a chamber with each contraction
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60 days
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Tissue doppler E/E' ratio (via echocardiogram)
Aikaikkuna: 60 days
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calculated as E wave divided by e' velocities
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60 days
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Composite outcome for neonatal cardiac surgery
Aikaikkuna: 60 days
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(per Graham, EM, et al) - binary variable defined as death, use of mechanical circulatory support, cardiac arrest requiring chest compressions, hepatic injury [2 times the upper limit of normal for AST or ALT], renal injury [Cr >1.5 mg/dL], or lactic acidosis [an increasing lactate >5 mmol/L in the postoperative period]
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60 days
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Yhteistyökumppanit ja tutkijat
Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.
Sponsori
Yhteistyökumppanit
Julkaisuja ja hyödyllisiä linkkejä
Tutkimusta koskevien tietojen syöttämisestä vastaava henkilö toimittaa nämä julkaisut vapaaehtoisesti. Nämä voivat koskea mitä tahansa tutkimukseen liittyvää.
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Opintojen ennätyspäivät
Nämä päivämäärät seuraavat ClinicalTrials.gov-sivustolle lähetettyjen tutkimustietueiden ja yhteenvetojen edistymistä. National Library of Medicine (NLM) tarkistaa tutkimustiedot ja raportoidut tulokset varmistaakseen, että ne täyttävät tietyt laadunvalvontastandardit, ennen kuin ne julkaistaan julkisella verkkosivustolla.
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Tähän tutkimukseen liittyvät termit
Muita asiaankuuluvia MeSH-ehtoja
- Sydänsairaudet
- Sydän-ja verisuonitaudit
- Kardiovaskulaariset poikkeavuudet
- Synnynnäiset poikkeavuudet
- Sydänvika, synnynnäinen
- Huumeiden fysiologiset vaikutukset
- Farmakologisen vaikutuksen molekyylimekanismit
- Entsyymin estäjät
- Antineoplastiset aineet
- Antimitoottiset aineet
- Mitoosin modulaattorit
- Suojaavat aineet
- Topoisomeraasi II:n estäjät
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- Kardiotoniset aineet
- Deksratsoksaani
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