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Published in: Trials 1/2009

Open Access 01-12-2009 | Study protocol

The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

Authors: Kim Houlind, Bo Juul Kjeldsen, Susanne Nørgaard Madsen, Bodil Steen Rasmussen, Susanne Juel Holme, Thomas Andersen Schmidt, Poul Erik Haahr, Poul Erik Mortensen, the DOORS study group

Published in: Trials | Issue 1/2009

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Abstract

Background

Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clamping. It has been hypothesized that when coronary artery by-pass grafting is performed without the use of CPB, the rate of serious complications is reduced.

Methods/Design

The trial is designed as an open, randomized, controlled, clinical trial with blinded assessment of end-points. Patients at or above 70 years of age, referred for surgical myocardial revascularisation, are included and randomised to receive coronary artery by-pass grafting either with or without the use of CPB and aortic cross-clamping. Follow-up is performed by clinical, biochemical, electrocardiographic, and angiographic data that are evaluated by independent committees that are blinded with respect to the result of the randomisation. End points include mortality, stroke, myocardial infarction, graft patency, quality of life, and cost-effectiveness. The trial is performed in four different Danish, cardiac surgery centres.

Trial registration

ClinicalTrials.gov NCT00123981
Literature
1.
go back to reference Cleveland JC, Shroyer LW, Chen AY, Peterson E, Grover FL: Off-pump Coronary Artery Bypass Grafting Decreases Risk-Adjusted Mortality and Morbidity. Ann Thorac Surg. 2001, 72: 1282-9. 10.1016/S0003-4975(01)03006-5.CrossRefPubMed Cleveland JC, Shroyer LW, Chen AY, Peterson E, Grover FL: Off-pump Coronary Artery Bypass Grafting Decreases Risk-Adjusted Mortality and Morbidity. Ann Thorac Surg. 2001, 72: 1282-9. 10.1016/S0003-4975(01)03006-5.CrossRefPubMed
2.
go back to reference DeMaria RG, Carrier M, Fortier S, Martineau R, Fortier A, Cartier R: Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation. 2002, 106 (12 Suppl 1): I5-I10.PubMed DeMaria RG, Carrier M, Fortier S, Martineau R, Fortier A, Cartier R: Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation. 2002, 106 (12 Suppl 1): I5-I10.PubMed
3.
go back to reference Al-Ruzzeh S, George S, Yacoub M, Amrani M: The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients. European Journal of Cardio-thoracic Surgery. 2001, 20: 1152-56. 10.1016/S1010-7940(01)00978-2.CrossRefPubMed Al-Ruzzeh S, George S, Yacoub M, Amrani M: The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients. European Journal of Cardio-thoracic Surgery. 2001, 20: 1152-56. 10.1016/S1010-7940(01)00978-2.CrossRefPubMed
4.
go back to reference Hirose H, Amano A, Takahashi A: Off-pump coronary artery bypass grafting for elderly patients. Ann Thorac Surg. 2001, 72 (6): 2013-9. 10.1016/S0003-4975(01)03147-2.CrossRefPubMed Hirose H, Amano A, Takahashi A: Off-pump coronary artery bypass grafting for elderly patients. Ann Thorac Surg. 2001, 72 (6): 2013-9. 10.1016/S0003-4975(01)03147-2.CrossRefPubMed
5.
go back to reference Nathoe HM, van Dijk D, Jansen EW, Suyker WJ, Diephuis JC, van Boven WJ, de la Riviere AB, Borst C, Kalkman CJ, Grobbee DE, Buskens E, de Jaegere PP, Octopus Study Group: A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med. 2003, 348 (5): 394-402. 10.1056/NEJMoa021775.CrossRefPubMed Nathoe HM, van Dijk D, Jansen EW, Suyker WJ, Diephuis JC, van Boven WJ, de la Riviere AB, Borst C, Kalkman CJ, Grobbee DE, Buskens E, de Jaegere PP, Octopus Study Group: A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med. 2003, 348 (5): 394-402. 10.1056/NEJMoa021775.CrossRefPubMed
6.
go back to reference Légaré J-F, Buth KJ, King , Sharon RN, Wood J, Sullivan JA, Friesen CH, Lee J, Stewart K, Hirsch GM: Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation. 2004, 24;109 (7): 887-92. 10.1161/01.CIR.0000115943.41814.7D.CrossRef Légaré J-F, Buth KJ, King , Sharon RN, Wood J, Sullivan JA, Friesen CH, Lee J, Stewart K, Hirsch GM: Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation. 2004, 24;109 (7): 887-92. 10.1161/01.CIR.0000115943.41814.7D.CrossRef
7.
go back to reference Angelini GD, Taylor FC, Reeves BC: Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002, 359: 1194-9. 10.1016/S0140-6736(02)08216-8.CrossRefPubMed Angelini GD, Taylor FC, Reeves BC: Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002, 359: 1194-9. 10.1016/S0140-6736(02)08216-8.CrossRefPubMed
8.
go back to reference Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach M, Huber P, Garas S, Sammons BH: Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003, 125: 797-808. 10.1067/mtc.2003.324.CrossRefPubMed Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach M, Huber P, Garas S, Sammons BH: Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003, 125: 797-808. 10.1067/mtc.2003.324.CrossRefPubMed
9.
go back to reference Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J: A Randomized Comparison of Off-Pump and On-Pump Multivessel Coronary-Artery Bypass surgery. N Engl J Med. 2004, 350: 21-8. 10.1056/NEJMoa031282.CrossRefPubMed Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J: A Randomized Comparison of Off-Pump and On-Pump Multivessel Coronary-Artery Bypass surgery. N Engl J Med. 2004, 350: 21-8. 10.1056/NEJMoa031282.CrossRefPubMed
10.
go back to reference Andersen TF, Madsen M, Jørgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull. 1999, 46: 263-268.PubMed Andersen TF, Madsen M, Jørgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull. 1999, 46: 263-268.PubMed
Metadata
Title
The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)
Authors
Kim Houlind
Bo Juul Kjeldsen
Susanne Nørgaard Madsen
Bodil Steen Rasmussen
Susanne Juel Holme
Thomas Andersen Schmidt
Poul Erik Haahr
Poul Erik Mortensen
the DOORS study group
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Trials / Issue 1/2009
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-10-47

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