Safety of Radial Artery as a Conduit for Coronary Artery Bypass Surgery in Patients with impaired Left Ventricular Function (Synopsis)

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Introduction / Background
Despite the fact that the use of RA as a conduit for coronary artery bypass grafting (CABG) is gaining in popularity worldwide and is being increasingly adopted by many cardiac surgeons, no data are available to assess the safety of RA as a conduit for CABG in patients with impaired left ventricular function. Since this subgroup of patients is more likely to receive inotropes and potent α-adrenergic agonists in the perioperative period, there is a potential for radial artery spasm with a possible fatal deterioration in the postoperative haemodynamics as well as detrimental effects on the graft patency. This randomised, controlled trial is designed and initiated to assess the safety of RA as a conduit for CABG in patients with impaired left ventricular function.
Objectives
1. To determine whether radial artery use is safe in patients with moderate to severe left ventricular dysfunction by determining the incidence of fatal or nonfatal myocardial infarction (MI) secondary to radial artery spasm due to administration of inotropic/vasopressor agents and comparing it with a control group which will not receive radial artery.
2. To determine the incidence of reoperative cardiac surgery, percutaneous coronary angioplasty (PTCA), and recurrent angina secondary to graft spasm.
3. To determine the incidence of complications specifically related to harvesting of the RA (hand claudication and thenar paresthesia).
Material and Methods
Hypothesis
The use of radial artery as a conduit for CABG in patients with moderate to severe left ventricle dysfunction is unsafe for the fear that being a muscular artery postoperative vasopressor support can cause its spasm resulting in possible fatal deterioration in the postoperative haemodynamics as well as detrimental effects on the graft patency.
Study Design : Interventional Study
Sample Size : 30 cases, 30 controls
Sampling Method : The randomisation sequence will be obtained by card allocation and strictly respected.
Duration of Study : 9 months
Inclusion Criteria
Patients referred by cardiology department for first time CABG with grade 3 to 4 left ventricular dysfunction will be included in this study. Confirmation of hibernating myocardium by isotope scan study prior to myocardial revascularization will be mandatory.
Exclusion Criteria
Patients with grade 1 or grade 2 left ventricular function ejection fraction and patients in grade 4 without any hibernating myocardium will be excluded. Patients with positive Allen�s test or previous injury to the non-dominant hand or forearm will also be excluded.
Data Collection Procedure
The nondominant arm will be used exclusively for RA harvesting, which will be performed simultaneously with harvesting of all other conduits. The RA will be dilated in situ by a slow intraluminal injection of 4�5 mL of a dilute solution of verapamil and papaverine (5 mg verapamil and 65 mg papaverine in 16 mL lactated Ringer’s solution).
Statistical Methods
Statistical analysis will be performed using the SPSS software for statistical analysis version 10.0, SPSS Inc. Continuous data will be expressed as mean�SD. Categorical variables will be compared with Chi square or Fisher�s exact test and the continuous variables will be compared with unpaired t test or the nonparametric Mann-Whitney rank-sum test. P value <0.05 will be considered significant




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