The Danish On-pump, Off-pump Randomization Study (DOORS)
The Impact of Avoiding Cardiopulmonary By-pass During Coronary Artery Bypass Surgery for Ischemic Heart Disease in Elderly Patients: The Danish On-pump, Off-pump Randomization Study (DOORS)
Background: Coronary artery bypass grafting (CABG) can be performed either with or without the use of cardiopulmonary bypass (CPB) to obtain myocardial re-vascularisation. The investigators hypothesize that CABG without the use of CPB may reduce the risk of perioperative death, stroke, myocardial infarction and other serious complications.
The aim of the present study is to compare the incidence of complications and the clinical efficacy of CABG with and without the use of CPB in elderly patients.
研究概览
详细说明
Conventional coronary artery bypass grafting (CCABG) using cardiopulmonary bypass has for decades been applied to obtain myocardial re-vascularisation and, hence, improved quality of life and survival. It does, however, bear a risk of death, stroke, myocardial infarction and other serious complications.
During recent years, an equivalent operation performed on the beating heart without cardiopulmonary bypass (off-pump coronary artery bypass grafting, OPCAB) has gained popularity helped by the advent of mechanical stabilization devices and improved surgical techniques. Observational studies suggest that this technique is associated with a lower incidence of stroke, per operative arrhythmias and even mortality than conventional CCABG. This is especially the case in elderly patients and patients with significant co-morbidity.
Only few randomised, controlled trials have been conducted and most of these included mainly or only low-risk, relatively young patients. These studies have documented the safety and efficacy of OPCAB compared with CCABG, but none of the trials has had the statistical strength to determine whether the rate of serious complications is lower after OPCAB operations. One recent study found graft patency to be significantly lower after OPCAB than after CCABG operations.
The investigators find that there is a need of a larger scale randomised trial to compare the results of CCABG and OPCAB operations, especially in elderly patients. This patient group is poorly represented in earlier randomised trials, whereas observational studies and theoretical considerations imply that they may benefit the most from avoiding cardiopulmonary bypass.
Aims: Primarily, to compare the incidence of death, stroke and myocardial infarction after CCABG and OPCAB procedures in a population of elderly patients. Furthermore, to compare quality of life and graft patency, and cost- effectiveness after CCABG and OPCAB.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Aarhus、丹麦、8200
- Dept. of Cardiothoracic and Vascular Surgery, Skejby Sygehus, Aarhus University Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Age seventy years or above
- Admitted for first time coronary artery bypass operation
Exclusion Criteria:
- Given information cannot be understood
- Aortic crossclamping not safe due to calcification
- Preoperative cardiac conditions demanding cardiopulmonary bypass
- Re-do cardiac surgery
- Patients requiring operation within the same day after conference
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器:CCABG
Coronary artery bypass surgery using cardiopulmonary bypass
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实验性的:OPCAB
Coronary artery bypass surgery NOT using cardiopulmonary bypass
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
---|---|
A combined endpoint of death + stroke + myocardial infarction within 30 days from operation
大体时间:30 days
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30 days
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次要结果测量
结果测量 |
大体时间 |
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A combined endpoint of death + stroke + myocardial infarction during follow-up
大体时间:3 years
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3 years
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Patency of bypass grafts assessed by coronary angiography 6 months after the operation
大体时间:6 months
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6 months
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Total mortality and cardiac mortality during follow-up
大体时间:3 years
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3 years
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Need of new intervention for cardiac angina during follow-up
大体时间:3 years
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3 years
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Quality of life assessed by MOS SF-36 and EuroQol questionnaires 6 months and 3 years after the operation
大体时间:6 months and 3 years
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6 months and 3 years
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Total hospital costs and costs of public care provided 6 months and 3 years after the operation and difference in costs per quality adjusted life year
大体时间:6 months and 3 years
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6 months and 3 years
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合作者和调查者
赞助
调查人员
- 首席研究员:Kim C Houlind, MD, PhD、Aarhus University Hospital
- 学习椅:Poul E Mortensen, MD、Odense University Hospital
出版物和有用的链接
一般刊物
- Houlind KC, Kjeldsen BJ, Terp KA, Madsen SN, Schmidt TA, Holme SJ, Mortensen PE. [Coronary artery bypass surgery without the use of a heart-lunch machine]. Ugeskr Laeger. 2005 May 9;167(19):2037-41. No abstract available. Danish.
- Houlind K, Fenger-Gron M, Holme SJ, Kjeldsen BJ, Madsen SN, Rasmussen BS, Jepsen MH, Ravkilde J, Aaroe J, Hansen PR, Hansen HS, Mortensen PE; DOORS Study Group. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). J Thorac Cardiovasc Surg. 2014 Nov;148(5):1812-1819.e2. doi: 10.1016/j.jtcvs.2014.02.024. Epub 2014 Feb 8.
- Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH, Mortensen PE; DOORS Study Group. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation. 2012 May 22;125(20):2431-9. doi: 10.1161/CIRCULATIONAHA.111.052571. Epub 2012 Apr 20.
- Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Schmidt TA, Haahr PE, Mortensen PE; DOORS study group. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS). Trials. 2009 Jul 4;10:47. doi: 10.1186/1745-6215-10-47.
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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