Operative Strategies To Reduce Cerebral Embolic Events During CABG

减少冠状动脉搭桥术期间脑栓塞事件的手术策略

• 批准号: 8875732
• 负责人: Michael Halkos
• 金额: $ 9.85万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8875732
• 关键词: Accounting; Anastomosis - action; Aorta; Arts; Brain Injuries; Bypass; Cannulations; Cardiac Surgery procedures; Cardiopulmonary Bypass; Cerebral Emboli; Cerebrum; Clinical Research; Coronary; Coronary Artery Bypass; Data; Devices; Distal; Embolism; Enrollment; Etiology; Event; Frequencies; Functional disorder; Generations; Goals; Heart; Heart Arrest; Incidence; Institution; Investigation; Joints; Knowledge; Literature; Maintenance; Master of Science; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Neurocognitive; Neurocognitive Deficit; Off-Pump Coronary Artery Bypass; Operative Surgical Procedures; Patients; Postoperative Period; Probability; Production; Public Health; Pump; Randomized; Research; Research Institute; Research Personnel; Schedule; Schools; Science; Severities; Signal Transduction; Stroke; Supervision; Surgeon; Techniques; Testing; Time; Training; Transcranial Doppler Ultrasonography; Translational Research; United States National Institutes of Health; Universities; ascending aorta; career; comparative effectiveness; compare effectiveness; didactic education; high risk; meetings; member; operation; patient oriented; programs; skills; tool

DESCRIPTION (provided by applicant): One of the most devastating complications of coronary artery bypass surgery (CABG) is postoperative stroke. While the etiology of stroke after CABG is multifactorial, atheroemboli generated during aortic manipulation is believed to account for most cerebral embolic events. Manipulation of the aorta during CABG occurs during aortic cannulation, institution and maintenance of cardiopulmonary bypass, and during aortic clamping and unclamping with either a cross-clamp, partial-occluding clamp, or both. One operative strategy to minimize aortic manipulation is to avoid cardiopulmonary bypass altogether by using off-pump techniques (OPCAB). Another method is to avoid the use of aortic clamps and to construct proximal aortocoronary anastomoses with facilitating devices that do not require aortic clamping. The effect of these strategies on reducing cerebral embolic events and the underlying mechanism for this reduction are not well-defined. This study will test the hypothesis that an off-pump (OPCAB) approach and facilitating devices to perform clampless proximal anastomoses will result in the least amount of aortic manipulation and therefore the lowest incidence and frequency of cerebral embolic events. The approach associated with the lowest incidence of TCD-detected cerebral embolic events will also result in the lowest incidence and severity of postoperative neurocognitive decline. Transcranial Doppler ultrasonography is an established method to detect cerebral embolic signals during cardiac surgery and will be utilized to detect cerebral embolic events during the operation. After an on- or off-pump strategy is selected, patients will be subsequently randomized to one of two clamping strategies. There will be 4 groups of patients: 1) OPCAB patients randomized to no clamping (facilitating device); 2) OPCAB patients randomized to partial clamping; 3) on-pump patients randomized to double clamping; and 4) on-pump patients randomized to a single clamp strategy. As part of the "Mentored Patient-Oriented Research Career Development Award" I will enroll in and complete an established, formal didactic curriculum leading to a Master of Science Degree in Clinical Research. This is an NIH-sponsored (NIH K30 CTSA) joint program offered by the Graduate School of Arts and Sciences at Emory University and the Atlanta Clinical and Translational Research Institute. This training will provide defined credentials and a body of knowledge which will provide me with the necessary skills to pursue a career in clinical research investigation. Mentorship will be provided during weekly meetings with the Division of Cardiothoracic Surgery's Clinical Research Unit, directed by my mentor, John D. Puskas, MD, as well as regularly scheduled meetings with my co-mentors and other members of the mentoring team. I will receive the appropriate training and supervision necessary to become an independent investigator conducting patient-centered clinical research. This has been my firm career goal since the start of my training in cardiothoracic surgery; I am committed to achieving this goal.

描述（由申请人提供）：冠状动脉搭桥手术（CABG）最具破坏性的并发症之一是术后中风。尽管CABG后的中风的病因是多因素的，但主动脉操作期间产生的动脉粥样硬化可以解释大多数脑栓塞事件。在CABG期间对主动脉的操纵发生在主动脉插管，机构和心肺旁路的维护期间，并在主动脉夹紧和与跨夹具，部分邻熟的夹具或两者兼而有之。最大程度地减少主动脉操作的一种手术策略是通过使用非泵技术（OPCAB）完全避免心肺旁路。另一种方法是避免使用主动脉夹，并构建不需要主动脉夹具的促进设备的近端主动脉吻合。这些策略对减少脑栓塞事件的影响以及这种减少的基本机制的影响不明确。 这项研究将检验以下假设：脉冲（OPCAB）方法和促进抗衰变近端吻合术的设备将导致主动脉操作量最少，从而导致大脑栓塞事件的发病率和频率最低。与TCD检测到的大脑栓塞事件发生率最低的方法还将导致术后神经认知下降的发病率和严重程度最低。经颅多普勒超声检查是一种在心脏手术过程中检测脑栓塞信号的既定方法，并将在手术过程中检测大脑栓塞事件。在选择了抗泵或销售策略之后，随后将随后将患者随机分为两种夹具策略之一。将有4组患者：1）Opcab患者随机进行无夹具（促进装置）； 2）opcab患者随机分解部分夹紧； 3）随机分配双夹具的泵式患者； 4）随机将泵的患者随机分配为单个夹具策略。 作为“以患者为导向的研究职业发展奖”的一部分，我将入学并完成一项既定，正式的教学课程，从而获得临床研究的理学硕士学位。这是NIH赞助的（NIH K30 CTSA）联合计划，由埃默里大学艺术与科学研究生院和亚特兰大临床和翻译研究所提供。这项培训将提供定义的证书和知识体系，这将为我提供从事临床研究调查职业的必要技能。由我的导师约翰·D·普斯卡斯（John D. Puskas，MD）指导的心胸外科手术部门的每周会议，以及与我的院长和我的辅导员和指导团队的其他成员定期举行会议。我将获得必要的适当培训和监督，以成为进行以患者为中心的临床研究的独立研究者。自从我接受心胸外科培训以来，这就是我的职业目标。我致力于实现这一目标。