Effect of Preliminary Administration of Cyclosporine (Sandimmun ®) on Different Markers of Cardiac Ischaemia Induced by Cardiopulmonary Bypass (Ciclo et CEC)
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Purpose
Observe the effect of preliminary cyclosporine administration on different markers of cardiac ischaemia led by the aortic cross-clamp during coronary artery bypass surgery with Cardiopulmonary bypass.
| Condition | Intervention | Phase |
|---|---|---|
|
Coronary Artery Bypass Surgery Cardiopulmonary Bypass |
Drug: Sandimmum Drug: Placebo |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Investigator) Primary Purpose: Prevention |
| Official Title: | Double-Blind Phase II Pilot Monocentric Randomized Clinical Trial Evaluating the Effect of a Preliminary Administration of Cyclosporine on Different Markers of Cardiac Ischemia Led by the Aortic Cross-clamp During Coronary Artery Bypass Surgery With Cardiopulmonary Bypass. |
- Area under curve and maximal blood level of both troponin-T and Creatine Kinase-MB after cardiopulmonary bypass [ Time Frame: at anaesthesia (ti), at the end of the cardiopulmonary bypass (t0), and 6 h, 12 h, 24 h,48h and 72h after the end of the cardiopulmonary bypass. ] [ Designated as safety issue: Yes ]
- Area under curve and maximal blood level of S100β protein [ Time Frame: at anaesthesia (ti), at the end of the cardiopulmonary bypass (t0), and 6 h, 12 h, 24 h,48h and 72h after the end of the cardiopulmonary bypass ] [ Designated as safety issue: Yes ]
- Spontaneous defibrillation at aorta declamping; Post surgical atrial fibrillation; ECG (new Q wave); Transthoracic Echocardiogram (diastolic and systolic function study, research of paradoxical septal motion, study of cardiac output)....) [ Time Frame: until Day 3 after the end of the cardiopulmonary bypass ] [ Designated as safety issue: Yes ]
- Levels of inflammatory cytokines (TNF alpha , IL-1 alpha et IL-1 beta, IL-6, IL-8, IL-10). C-reactive protein (CRP) level [ Time Frame: until day 8 after the end of the cardiopulmonary bypass ] [ Designated as safety issue: Yes ]
- Creatine blood levels [ Time Frame: until 3 months after the end of the cardiopulmonary bypass ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 50 |
| Study Start Date: | April 2009 |
| Estimated Study Completion Date: | July 2011 |
| Primary Completion Date: | May 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: cyclosporin
Intravenous cyclosporin injection.
|
Drug: Sandimmum
Intravenous injection of cyclosporine
|
|
Placebo Comparator: Pacebo
Intravenous injection of NaCl solution.
|
Drug: Placebo
Intravenous Injection of NaCl solution
|
Detailed Description:
The coronary artery bypass surgery, in spite of substantial improvements during the last years, is still associated to a post-operative mortality and morbidity: myocardial infarction, heart failure, cardiac arrhythmia, renal failure, Stroke.
These complications are often due to ischaemia - reperfusion injury event. Recent studies showed that in case of cellular stress (in particular during the reperfusion after ischaemia) a not specific pore, called Mitochondrial permeability transition Pore (MPTP), could be opened. That caused the loss of ion homeostasis, then cell death as well as by apoptosis as by necrosis.
Prevent the opening of this MPTP during the myocardial reperfusion after coronary bypass, for example, is an important objective to improve the cardioprotection.
The Cyclosporin A, prevents the MPTP from opening. Several studies have shown an cytoprotection led by cyclosporin A, after ischaemia reperfusion in several models as isolated rats heart, in vivo rats heart and ex vivo myocardial ( atrial ) human tissues.
Recently, a multicentric study performed in humans, during the acute phase of myocardial infarction, showed a reduction of infarct size by approximately 40% in the cyclosporine group compared to control group.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patient hospitalized for a coronary artery bypass surgery
- Not urgent surgery
- Left ventricular ejection fraction (LVEF)> 40 %
- 18 years and older
- patient who have sign the informed consent form
- Affiliation to the French Social Security.
Exclusion Criteria:
- Beating heart surgery with or without Cardiopulmonary Bypass
- Patient receiving another surgical gesture combined to the CABG
- Myocardial infarction or vascular cerebral attack less than 30 days
- Previous History of cardiac surgery;
- Renal failure (creatinine > 200 µmol/l)
- Uncontrolled hypertension
- hyperkaliemy;
- hyperuricemy;
- Acute Coronary Syndrome
- Malignant tumor
- Unchecked infection
- Previous intravenous administration of Sandimmun ®;
- allergy to ciclosporin, ethyl alcohol, castor oil or nitrogen
- Pregnant Woman, parturient without contraception, or breast-feeding
- Age < 18 years
- Patient who have not signed the form of consent;
- Patient Under guardianship or being the object of a legal protective measure
Contacts and Locations| France | |
| Department of cardiac surgery - University Hospital of Grenoble | |
| Grenoble,, France, 38043 | |
| Principal Investigator: | Vincent BACH, MD | Cardiac Surgery Department - University Hospital of Grenoble, |
More Information
Publications:
| Responsible Party: | University Hospital of Grenoble, Direction de la Recherche Clinique |
| ClinicalTrials.gov Identifier: | NCT01002859 History of Changes |
| Other Study ID Numbers: | DCIC 08 04 |
| Study First Received: | October 26, 2009 |
| Last Updated: | June 8, 2011 |
| Health Authority: | France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis) |
Keywords provided by University Hospital, Grenoble:
|
Coronary artery bypass graft surgery (CABG) Cardiopulmonary Bypass (CPB) Cyclosporine ischaemia reperfusion |
Additional relevant MeSH terms:
|
Coronary Artery Disease Myocardial Ischemia Ischemia Coronary Disease Heart Diseases Cardiovascular Diseases Arteriosclerosis Arterial Occlusive Diseases Vascular Diseases Pathologic Processes Cyclosporins Cyclosporine |
Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antifungal Agents Anti-Infective Agents Therapeutic Uses Dermatologic Agents Antirheumatic Agents |
ClinicalTrials.gov processed this record on May 23, 2013