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Combined valvular and coronary artery bypass grafting (CABG) surgery requires a long period of cardioplegic arrest (CA), that predisposes the heart to reperfusion injury, which is associated with increased in-hospital mortality, low cardiac output syndrome, reperfusion arrhythmias and costs.
Therefore procedures that can reduce the duration of CA would be expected to reduce intraoperative and postoperative complications. We have explored a novel surgical approach, aimed at reducing the CA time for these patients, by initially performing CABG on cardiopulmonary bypass (CPB) on the beating heart and without CA, followed by valve surgery on an arrested heart. Our preliminary results suggest that this leads to a significant shortening of the CA time and fewer postoperative complications compared to conventional surgery using CA throughout. We propose to carry out a randomised controlled trial to ascertain the safety and efficacy of this approach compared to conventional surgery in patients undergoing combined coronary and valvular surgery. Ischaemic metabolic stress, reperfusion cardiac injury, functional and clinical outcomes will be compared.
Design
Eligible patients undergoing surgery for concomitant valve and coronary disease who consent to participate will be randomly allocated to conventional surgery or hybrid surgery:
- Conventional surgery group: both coronary and valvular surgery will be performed on heart arrested using cold blood cardioplegia.
- Hybrid surgery group: coronary surgery will be carried out first on the beating heart with CPB but without CA. Cardioplegic arrest will be then induced and valve surgery will be performed in a conventional way.
All adults having first-time combined coronary and valvular surgery represent the target population. Eligibility for surgery is based on medical history, echocardiography and the most recent angiogram. Preoperative angiograms and transthoracic echocardiography will be used to confirm the diagnosis of significant valve disease.
Inclusion criteria
- Adults with coronary disease and any aortic valve disease and/or any mitral valve disease;
- Surgeons willing to carry out operation via either method.
Exclusion criteria
- Reoperation;
- Malignancy;
- Debilitating neurological disease;
- Ongoing sepsis or endocarditis;
- Emergency or salvage procedures.
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If you require any help, please contact: Dr Chris Rogers |
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