AzTrials
AzTrials

Aortic Valve DiseasePhase 4NCT06235424

Del Nido Versus HTK Cardioplegia in Adult Aortic Valve Replacement

A Phase 4 study testing Del Nido Cardioplegia Solution and HTK solution in people with Aortic Valve Disease and Valve Disease, Heart, run by Medical University of Gdansk at 1 site in Poland.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

The goal of this clinical trial is to compare del Nido and Bretschneider-HTK (HTK) cardioplegia solutions in patients undergoing elective aortic valve replacement. The main question it aims to answer is: Does the del Nido cardioplegia provide better cardioprotection and clinical outcomes than HTK cardioplegia?… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Del Nido Cardioplegia Solution and HTK solution
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 sitePoland
Study dates
1 Oct 2018to 24 Sep 2024
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • patients aged 18 and over,
  • qualified for elective isolated aortic valve replacement (AVR)

Who cannot join

  • patients with significant coronary artery disease,
  • urgent cases,
  • cases with additional cardiac procedures.

Trial locations and contacts

1 site in 1 country.

Poland1 site
  • Medical University of Gdańsk

    Gdansk, Pomeranian Voivodeship, 80-282

Other trials in Poland

About this study

Official title: Comparison of Low Sodium Crystalloid Bretschneider-HTK Cardioplegia With Del Nido Cardioplegia in Patients Undergoing Elective Aortic Valve Replacement - a Prospective Randomized Trial

The goal of this clinical trial is to compare del Nido and Bretschneider-HTK (HTK) cardioplegia solutions in patients undergoing elective aortic valve replacement. The main question it aims to answer is:

  • Does the del Nido cardioplegia provide better cardioprotection and clinical outcomes than HTK cardioplegia? Participants will receive one of the investigated cardioplegia solutions according to the randomization.

Researchers will compare both groups in terms of cardioprotection (described as levels of CK-MB and hsTnI), in-hospital clinical outcomes, biochemical changes in coronary sinus blood and one-year follow-up.

Read the detailed description

The idea of using del Nido cardioplegia in adult cardiac surgery appeared after many reports proving its safety and efficacy in the paediatric population. Therefore many adult centres started to apply it in everyday practice. Despite its growing popularity and application in different types of cardiac surgeries, there is still an insufficient number of prospective randomized trials which compare del Nido cardioplegia with the Bretschneider-HTK formula in the adult population.

The described problem will be analyzed at different levels in this prospective, randomised study.

Clinical aspects - del Nido and HTK cardioplegia will be compared in terms of intraoperative and postoperative details such as perfusion details and concentration of cardiac enzymes.

Echocardiographic changes - The next step will be revealing potential echocardiographic changes in cardiac function in short- and long-term observations after cardiac surgery.

Metabolic changes - the metabolic profile of amino acids and nucleotide changes after each cardioplegia solution delivery will be analyzed.

Statistical calculations will be performed by a qualified statistician. In the case of binary variables, Fisher's exact test will be used to assess differences between groups. In the case of quantitative variables, the compliance of the distribution with the normal distribution will be tested using the Shapiro-Wilk test. For quantitative variables with a distribution not significantly different from normal, the Student's t-test will be used for comparison between groups. If the distribution differs significantly from the normal distribution, the Mann-Whitney U test (comparisons of two samples) or the Kruskal-Wallis test (comparisons of many samples) will be used. Correlations between variables will be assessed using the Pearson or Spearman method, depending on the distribution of the variables. Repeated-measures ANOVA will be used to assess the variability of biochemical parameters over time.

In all analyses, p<0.05 will be considered as the level of statistical significance.

A comparison of the two cardioplegia solutions would allow assessing whether del Nido provides better cardioprotection than HTK.

Being tested
Del Nido Cardioplegia Solution, HTK solution
Keywords
del Nido cardioplegia, Bretschneider HTK cardioplegia, cardioprotection, cardiac surgery, aortic valve replacement
Medical subject headings
Aortic Valve Disease, Heart Valve Diseases, Coronary Artery Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Del Nido Cardioplegia SolutionDrug

    Also called del Nido, DNC

    The route of cardioplegia delivery differed according to surgeons' preferences. The total dosage of cardioplegia depends on the type of cardioplegia. The standard dose of del Nido cardioplegia in our institution is 1000 ml as an initial dose and is delivered with a system pressure of 90-150 mmHg. The solution is prepared by our hospital's pharmacy. At 60. minute of cross-clamp (XC) if XC time was expected to exceed 90 minutes another dose of solution would be delivered. The volume of an additional dose was 500 ml. The temperature of the delivered del Nido cardioplegia was 4*C.

  • HTK solutionDrug

    Also called HTK, Bretschneider-HTK

    The route of cardioplegia delivery differed according to surgeons' preferences. The dose of the HTK cardioplegia is calculated with an application of 20 mL/kg rule. It is delivered with a system pressure of 90-150 mmHg. If the XC time exceeds 120 minutes additional dose is given (10 mL/kg rule). The temperature of the delivered crystalloid cardioplegia is 4*C

Study groups in NCT06235424
Study groupRoleWhat they receive
del Nido cardioplegia groupActive comparatorA group of patients that received high potassium cardioplegic solution with the addition of lidocaine, mixed with the patient's blood in 4:1 ratio
Receives: Drug: Del Nido Cardioplegia Solution
Bretschneider-HTK cardioplegia groupActive comparatorA group of patients that received low sodium cardioplegic solution with the addition of histidine, tryptophan and alpha-ketoglutarate
Receives: Drug: HTK solution

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. postoperative CK-MB

    concentration of serum creatine kinase-myocardial band (CK-MB)

    Measured: measured in the 6th, 24th, and 48th hour postoperatively

  2. postoperative hsTnI

    concentration of serum high sensitive cardiac troponin I (hsTnI)

    Measured: measured in the 6th, 24th, and 48th hour postoperatively

Secondary outcomes (46)
  1. CPB time

    Time of cardiopulmonary bypass (CPB).

    Measured: intraoperative

  2. XC time

    Time of aortic cross-clamp (XC).

    Measured: intraoperative

  3. Reperfusion time

    Time of reperfusion (between removal of cross-clamp and weaning from cardiopulmonary bypass).

    Measured: intraoperative

  4. Cardioplegia volume

    Total volume cardioplegia doses.

    Measured: intraoperative

  5. Cardioplegia doses

    Number of cardioplegia doses.

    Measured: intraoperative

  6. Heart rhythm after XC

    Type of heart rhythm after removal of aortic cross-clamp.

    Measured: intraoperative

  7. Need for defibrillation

    Need for heart defibrillations in case of ventricular fibrillation.

    Measured: intraoperative

  8. Number of defibrillations

    Number of heart defibrillations in case of ventricular fibrillation.

    Measured: intraoperative

  9. Intraoperative lactate concentration

    Lactate measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  10. Intraoperative pH results

    pH measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  11. Intraoperative partial pressure of oxygen

    Partial pressure of oxygen measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  12. Intraoperative partial pressure of carbon dioxide

    Partial pressure of carbon dioxide measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  13. Intraoperative base deficit

    Base deficit measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  14. Intraoperative sodium and potassium concentration

    Sodium and potassium concentration measured before XC, at the time of the biggest hemodilution, and after CPB.

    Measured: intraoperative

  15. Intraoperative amino acids concentrations

    Changes of amino acid concentrations in systemic and coronary sinus blood Before the procedure - sample from the peripheral arterial line before the start of the procedure.

    During cardiopulmonary bypass - samples from the peripheral arterial line and samples from the coronary sinus at 1. and 5. minute after aortic cross-clamp removal. Blood from the coronary sinus would be collected by cannula for retrograde cardioplegia delivery.

    During reperfusion - peripheral arterial line blood sample would be collected after weaning from cardiopulmonary bypass.

    Measured: intraoperative

  16. Intraoperative nucleotides concentrations

    changes of nucleotides concentrations in systemic and coronary sinus blood Before the procedure - sample from the peripheral arterial line before the start of the procedure.

    During cardiopulmonary bypass - samples from the peripheral arterial line and samples from the coronary sinus at 1. and 5. minute after aortic cross-clamp removal. Blood from the coronary sinus would be collected by cannula for retrograde cardioplegia delivery.

    During reperfusion - peripheral arterial line blood sample would be collected after weaning from cardiopulmonary bypass.

    Measured: intraoperative

  17. Ventilation time

    Time of mechanical ventilation after surgery.

    Measured: 30 postoperative days

  18. ICU length of stay

    Intensive care unit (ICU) length of stay.

    Measured: 30 postoperative days

  19. Hospital length of stay

    Hospital length of stay.

    Measured: 30 postoperative days

  20. Postoperative lactate concentration

    Lactate measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  21. Postoperative pH results

    pH measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  22. Postoperative partial pressure of oxygen

    Partial pressure of oxygen measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  23. Postoperative partial pressure of carbon dioxide

    Partial pressure of carbon dioxide measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  24. Postoperative base deficit

    Base deficit measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  25. Postoperative sodium and potassium levels

    Sodium and potassium levels measured at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  26. Maximum CRP concentration

    Maximum C reactive protein (CRP) concentration measured during hospitalization at our institution.

    Measured: 30 postoperative days

  27. Discharge CRP concentration

    CRP results at discharge from our institution.

    Measured: 30 postoperative days

  28. Maximum creatinine concentration

    Maximum creatinine concentration measured during hospitalization at our institution.

    Measured: 30 postoperative days

  29. Discharge creatinine concentration

    Creatinine results at discharge from our institution.

    Measured: 30 postoperative days

  30. Discharge Hb concentration

    Hemoglobin (Hb) results at discharge from our institution.

    Measured: 30 postoperative days

  31. Discharge Hct concentration

    Hematocrit (Hct) results at discharge from our institution.

    Measured: 30 postoperative days

  32. Discharge WBC concentration

    White blood cells count (WBC) results at discharge from our institution.

    Measured: 30 postoperative days

  33. VIS

    Vasoactive-inotropic score (VIS) at 6th, 24th, and 48th hour postoperatively.

    Measured: 30 postoperative days

  34. Rate of postoperative transfusions

    Rate of postoperative blood product transfusions.

    Measured: 30 postoperative days

  35. Rate of resternotomy

    Rate of bleeding with the need for re-sternotomy during the early postoperative period.

    Measured: 30 postoperative days

  36. Rate of pericardial drainage

    Rate of pericardial drainages during the early postoperative period.

    Measured: 30 postoperative days

  37. Rate of stroke

    Rate of stokes during the early postoperative period.

    Measured: 30 postoperative days

  38. Rate of myocardial infarction

    Rate of myocardial infarction during the early postoperative period.

    Measured: 30 postoperative days

  39. Rate of new-onset arrhythmias

    Rate of new-onset arrhythmias (atrial fibrillation, heart block) during the early postoperative period.

    Measured: 30 postoperative days

  40. In-hospital mortality rate

    Rate of postoperative deaths that occurred during initial hospitalization.

    Measured: 30 postoperative days

  41. Out-hospital mortality rate

    Rate of postoperative deaths that occurred after hospital discharge.

    Measured: approx one year postoperatively

  42. Rate of pacemaker implantation

    Pacemaker implantation in postoperative period.

    Measured: approx one year postoperatively

  43. Rate of secondary hospitalization

    Rate of secondary hospitalization due to late complications or other cardiac-related reasons

    Measured: approx one year postoperatively

  44. LVEF values changes

    Left ventricular ejection fraction (LVEF) will be measured during an echocardiography test before surgery, before discharge and one year after surgery.

    Measured: approx one year postoperatively

  45. Diastolic function changes

    Diastolic function measured during an echocardiography test before surgery, before discharge and one year after surgery.

    Measured: approx one year postoperatively

  46. 2STE parameter changes

    2STE parameter changes (with special attention put on the ventricular septum, new hypokinetic or akinetic areas) measured during an echocardiography test before surgery, before discharge and one year after surgery.

    Measured: approx one year postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Jan 2024
  2. Study start1 Oct 2018
  3. Primary completion24 Apr 2023
  4. Study completion24 Sep 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06235424
Sponsor's protocol ID
NKBBN/203/2018
Status last verified
Jan 2024
First submitted
5 Dec 2023
Last updated
31 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data obtained through this study may be provided to qualified researchers with an interest in cardioprotection. Data or samples shared will be coded, with no PHI included. The data underlying this article will be shared on reasonable request.

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Del Nido Cardioplegia Solution and HTK solution in people with Aortic Valve Disease and Valve Disease, Heart, run by Medical University of Gdansk at 1 site in Poland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 31 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Poland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

postoperative CK-MB (time frame: measured in the 6th, 24th, and 48th hour postoperatively). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Jan 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in