Off-pump versus on-pump coronary artery bypass grafting in frail patients: study protocol for the fragile multicenter randomized controlled trial
Rev. bras. cir. cardiovasc
; 32(5): 428-434, Sept.-Oct. 2017. tab
Artigo
em Inglês
| LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-897942
Biblioteca responsável:
BR1.1
ABSTRACT
Abstract Introduction:
Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress. In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients.Methods:
FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (11) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and coronary reintervention. Secondary outcomes will be major adverse cardiac and cerebrovascular events, operative time, mechanical ventilation time, hyperdynamic shock, new onset of atrial fibrillation, renal replacement therapy, reoperation for bleeding, pneumonia, length of stay in intensive care unit, length of stay in hospital, number of units of blood transfused, graft patency, rate of complete revascularization, neurobehavioral outcomes after cardiac surgery, quality of life after cardiac surgery and costs.Discussion:
FRAGILE trial will determine whether off-pump CABG is superior to conventional on-pump CABG in the surgical treatment of pre-frail and frail patients. Trial registration ClinicalTrials.gov, ID NCT02338947. Registered on August 29th 2014; last updated on March 21st 2016.
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
LILACS
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Sec. Est. Saúde SP
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SESSP-IDPCPROD
Assunto principal:
Ponte de Artéria Coronária
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Ponte de Artéria Coronária sem Circulação Extracorpórea
Tipo de estudo:
Ensaio clínico controlado
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Estudo de etiologia
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Estudo observacional
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Estudo prognóstico
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Fatores de risco
Aspecto:
Preferência do paciente
Limite:
Idoso
/
Humanos
Idioma:
Inglês
Revista:
Rev. bras. cir. cardiovasc
Ano de publicação:
2017
Tipo de documento:
Artigo
Instituição/País de afiliação:
Hospital Alberto Urquiza Wanderley Unimed/BR
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Hospital Beneficência Portuguesa de São Paulo/BR
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Instituto Dante Pazzanese de Cardiologia/BR
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Instituto Nacional de Cardiologia (INC)/BR
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Instituto de Cardiologia do Distrito Federal/BR
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Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP)/BR
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Mount Sinai Heart at Mount Sinai Saint Luke's New York/US
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Pontificia Universidade Católica do Paraná (PUCPR)/BR
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Total Cor Hospital/BR
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Universidade de Pernambuco (UPE)/BR