Use of the Cardioprotectant Dexrazoxane During Congenital Heart Surgery
2 de agosto de 2021 atualizado por: 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.
Visão geral do estudo
Status
Recrutamento
Condições
Intervenção / Tratamento
Descrição detalhada
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.
Tipo de estudo
Intervencional
Inscrição (Antecipado)
12
Estágio
- Fase 1
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Contato de estudo
- Nome: Daniel Stromberg, MD
- Número de telefone: 512-324-3357
- E-mail: dstromberg@austin.utexas.edu
Estude backup de contato
- Nome: Jacob Strelow, MPH
- Número de telefone: 757-268-2691
- E-mail: strelow.jacob@austin.utexas.edu
Locais de estudo
-
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Texas
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Austin, Texas, Estados Unidos, 78723
- Recrutamento
- Dell Children's Medical Center of Central Texas
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Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
1 segundo a 1 ano (Filho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
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
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: N / D
- Modelo Intervencional: Atribuição de grupo único
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: 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).
Outros nomes:
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Concentração plasmática máxima (Cmax)
Prazo: 24 horas
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24 horas
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Area under the plasma concentration vs time curve (AUC)
Prazo: 24 hours
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24 hours
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Minimum plasma concentration (Cmin)
Prazo: 24 hours
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24 hours
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Time to resolution of organ failure
Prazo: 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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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Myocardial Injury
Prazo: 7 days
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determined by elevated serum cardiac troponin
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7 days
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Oxidative Stress
Prazo: 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)
Prazo: 3 days
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3 days
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Neurologic IR injury
Prazo: 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
Prazo: 60 days
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60 days
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Hospital Length of Stay
Prazo: 60 days
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60 days
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Tei Index (via echocardiogram)
Prazo: 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)
Prazo: 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)
Prazo: 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
Prazo: 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
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Colaboradores
Publicações e links úteis
A pessoa responsável por inserir informações sobre o estudo fornece voluntariamente essas publicações. Estes podem ser sobre qualquer coisa relacionada ao estudo.
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Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Real)
9 de abril de 2021
Conclusão Primária (Antecipado)
1 de outubro de 2021
Conclusão do estudo (Antecipado)
1 de janeiro de 2022
Datas de inscrição no estudo
Enviado pela primeira vez
21 de julho de 2021
Enviado pela primeira vez que atendeu aos critérios de CQ
2 de agosto de 2021
Primeira postagem (Real)
9 de agosto de 2021
Atualizações de registro de estudo
Última Atualização Postada (Real)
9 de agosto de 2021
Última atualização enviada que atendeu aos critérios de controle de qualidade
2 de agosto de 2021
Última verificação
1 de agosto de 2021
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
- Doenças cardíacas
- Doenças cardiovasculares
- Anormalidades cardiovasculares
- Anomalias congénitas
- Defeitos Cardíacos Congênitos
- Efeitos Fisiológicos das Drogas
- Mecanismos Moleculares de Ação Farmacológica
- Inibidores Enzimáticos
- Agentes Antineoplásicos
- Agentes Antimitóticos
- Moduladores de Mitose
- Agentes de proteção
- Inibidores da Topoisomerase II
- Inibidores da Topoisomerase
- Agentes cardiotônicos
- Dexrazoxane
- Razoxane
Outros números de identificação do estudo
- 2020-02-0075
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Sim
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
produto fabricado e exportado dos EUA
Não
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