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Myocardial protection is a fundamental element for the safety of patients when performing cardiac surgery. For this purpose, cardioplegia were rapidly established in clinical practice to protect the myocardium when performing aortic clamp.
Cardioplegia are procedures to stop the contraction of myocardium. It is usually achieved with the use of chemicals ( cardioplegic solutions) or cold temperature (such as chilled perfusate). The composition of the cardioplegic solutions and their method of administration continuously changed over the years.
At the present date, cold blood cardioplegias are performed in the investigator's center. The investigators regularly use two modes of administration: either by an antegrade path (injection in the coronary arteries), or a retrograde one (injection in the venous system). At present, there are no elements supporting the superiority or inferiority of one path compared to another. The difficulty lies within a clear estimation of the contractility state of the ventricular cardiac muscle.
Technological developments in recent years provided a solution to this problem. The analysis of the pressure/volume curves generated by a ventricle allows an accurate quantification of the myocardial contractility. This requires the use of conductance catheters to accurately measure the ventricular volume and the ventricular pressure. The absolute ventricular contractility is then deduced with the help of a software.
The investigators intend to use this pressure-volume loops, obtained with conductance catheters, to compare the contractility of the right heart ventricle after antegrade vs retrograde cardioplegia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Antegrade Cardioplegia | Active Comparator | Coronary artery bypass grafting (CABG) surgery in patients with a normal left ventricular ejection fraction (FEVG) |
|
| Retrograde Cardioplegia | Experimental | Coronary artery bypass grafting (CABG) surgery in patients with a normal left ventricular ejection fraction (FEVG) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Antegrade cardioplegia | Procedure | Injection of the cardioplegia in the coronary arteries |
|
| Measure | Description | Time Frame |
|---|---|---|
| Contractility index of the right ventricle | Cardiac surgery is performed according to the standard of care. The intraventricular pressure and the ventricular volume, measured with a conductance catheter, are combined within a software to compute the contractility index of the right ventricle. The baseline measure will be performed before the instauration of the extracorporeal blood circulation, during the cardiac surgery. | Baseline |
| Contractility index of the right ventricle | Cardiac surgery is performed according to the standard of care. The intraventricular pressure and the ventricular volume, measured with a conductance catheter, are combined within a software to compute the contractility index of the right ventricle. This will be measured at the end of the cardiac surgery, immediately after discontinuation of the extracorporeal circulation, with absence of inotropic support. | immediately after discontinuation of the extracorporeal blood circulation (end of cardiac surgery according to standard of care - up to 4h) |
| Contractility index of the right ventricle | Cardiac surgery is performed according to the standard of care. The intraventricular pressure and the ventricular volume, measured with a conductance catheter, are combined within a software to compute the contractility index of the right ventricle. This will be measured at the end of the cardiac surgery, 10 minutes after discontinuation of the extracorporeal circulation, with absence of inotropic support. | 10 minutes after discontinuation of the extracorporeal blood circulation |
| Contractility index of the right ventricle | Cardiac surgery is performed according to the standard of care. The intraventricular pressure and the ventricular volume, measured with a conductance catheter, are combined within a software to compute the contractility index of the right ventricle. This will be measured at the end of the cardiac surgery, 20 minutes after discontinuation of the extracorporeal circulation, with absence of inotropic support. |
| Measure | Description | Time Frame |
|---|---|---|
| Troponin post operative level | The investigators would like to measure post operative troponin levels as a biological marker of myocardial protection | 6h post surgery |
| Troponin post operative level |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Pierre Wauthy, MD, Pr | CHU Brugmann | Principal Investigator |
| Alessandro Falchetti, MD | CHU Brugmann | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU Brugmann | Brussels | 1020 | Belgium |
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| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| Retrograde cardioplegia | Procedure | Injection of the cardioplegia in the venous system |
|
| 20 minutes after discontinuation of the extracorporeal blood circulation |
The investigators would like to measure post operative troponin as a biological marker of myocardial protection.
| 12h post surgery |
| Troponin post operative level | The investigators would like to measure post operative troponin as a biological marker of myocardial protection. | 24h post surgery |