TY - JOUR
T1 - Protocol of supra-visceral aortic ischemic preconditioning for open surgical repair of thoracoabdominal aortic aneurysm
T2 - The EPICATA study (Evaluation of the Efficacy of Ischemic PreConditioning on morbidity and mortality in open ThoracoAbdominal Aortic surgery)
AU - Palmier, Mickael
AU - Bubenheim, Mickael
AU - Chiche, Laurent
AU - Chaufour, Xavier
AU - Koskas, Fabien
AU - Fadel, Elie
AU - Magnan, Pierre Edouard
AU - Ducasse, Eric
AU - Chakfe, Nabil
AU - Steinmetz, Eric
AU - Dusseaux, Marie Melody
AU - Ricco, Jean Baptiste
AU - Plissonnier, Didier
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/8/27
Y1 - 2020/8/27
N2 - BACKGROUND: Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAA) is associated with a high pulmonary and renal morbidity rate. Ischemic preconditioning (IPC) is a mechanism of protection against the deleterious effects of ischemia-reperfusion. To our knowledge IPC has never been tested during OSR for TAA.METHODS: The primary objective of the study is to evaluate the efficacy of IPC during OSR for TAA with respect to acute kidney injury (AKI) according to KDIGO and pneumonia/prolonged ventilation-time during the first 8 postoperative days. The secondary objectives are to compare both arms with respect to cardiac complications within 48 h, renal and pulmonary complications within 21 days and mortality at 60 days. To assess the efficacy of IPC with respect to pulmonary and renal morbidity, a cox model for competing risks will be used. Assuming that the event occurs among 36% of the patients when no IPC is performed, the allocation of 55 patients to each arm should allow detecting a hazard ratio of at least 2.75 with a power of 80% when admitting 5% for an error of first kind. This means that 110 patients, enrolled in this multicenter study, may be randomised within 36 months of the first randomization. Randomization will be performed to allocate patients either to surgery with preconditioning before aortic cross clamping (Arm 1) or to surgery without preconditioning before aortic cross clamping (Arm 2). Randomization takes place during the intervention after intravenous injection of heparin, or after the start of femoral assistance. The procedure for IPC will be a supra-visceral thoracic aortic cross clamping for 5 min followed by an unclamping period of 5 min. This procedure will be repeated twice before starting thoracic aortic cross clamping needed to perform surgery.CONCLUSIONS: Our hypothesis is that ischemic preconditioning could reduce clinical morbidity and the incidence of lung damage associated with supra-visceral aortic clamping.TRIAL REGISTRATION: EPICATAStudy registered in ClinicalTrial.gov / number: NCT03718312 on Oct.24.2018 URL number.
AB - BACKGROUND: Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAA) is associated with a high pulmonary and renal morbidity rate. Ischemic preconditioning (IPC) is a mechanism of protection against the deleterious effects of ischemia-reperfusion. To our knowledge IPC has never been tested during OSR for TAA.METHODS: The primary objective of the study is to evaluate the efficacy of IPC during OSR for TAA with respect to acute kidney injury (AKI) according to KDIGO and pneumonia/prolonged ventilation-time during the first 8 postoperative days. The secondary objectives are to compare both arms with respect to cardiac complications within 48 h, renal and pulmonary complications within 21 days and mortality at 60 days. To assess the efficacy of IPC with respect to pulmonary and renal morbidity, a cox model for competing risks will be used. Assuming that the event occurs among 36% of the patients when no IPC is performed, the allocation of 55 patients to each arm should allow detecting a hazard ratio of at least 2.75 with a power of 80% when admitting 5% for an error of first kind. This means that 110 patients, enrolled in this multicenter study, may be randomised within 36 months of the first randomization. Randomization will be performed to allocate patients either to surgery with preconditioning before aortic cross clamping (Arm 1) or to surgery without preconditioning before aortic cross clamping (Arm 2). Randomization takes place during the intervention after intravenous injection of heparin, or after the start of femoral assistance. The procedure for IPC will be a supra-visceral thoracic aortic cross clamping for 5 min followed by an unclamping period of 5 min. This procedure will be repeated twice before starting thoracic aortic cross clamping needed to perform surgery.CONCLUSIONS: Our hypothesis is that ischemic preconditioning could reduce clinical morbidity and the incidence of lung damage associated with supra-visceral aortic clamping.TRIAL REGISTRATION: EPICATAStudy registered in ClinicalTrial.gov / number: NCT03718312 on Oct.24.2018 URL number.
KW - Preconditioning
KW - Pulmonary and renal morbidity
KW - Thoracoabdominal aortic aneurysm
KW - Constriction
KW - Humans
KW - Treatment Outcome
KW - Acute Kidney Injury/etiology
KW - Cardiopulmonary Bypass
KW - Reperfusion Injury/etiology
KW - Aorta/surgery
KW - Morbidity
KW - Randomized Controlled Trials as Topic
KW - Aortic Aneurysm, Thoracic/complications
KW - Lung Diseases/etiology
KW - Hypothermia, Induced
KW - Heart Diseases/etiology
KW - Ischemia/etiology
KW - Blood Vessel Prosthesis Implantation
KW - Ischemic Preconditioning/methods
UR - http://www.scopus.com/inward/record.url?scp=85089999337&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089999337&partnerID=8YFLogxK
U2 - 10.1186/s12893-020-00851-3
DO - 10.1186/s12893-020-00851-3
M3 - Article
C2 - 32854681
AN - SCOPUS:85089999337
SN - 1471-2482
VL - 20
SP - 193
JO - BMC surgery
JF - BMC surgery
IS - 1
M1 - 193
ER -