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Trial registered on ANZCTR
Registration number
ACTRN12621000278831
Ethics application status
Approved
Date submitted
10/02/2021
Date registered
12/03/2021
Date last updated
12/03/2021
Date data sharing statement initially provided
12/03/2021
Type of registration
Prospectively registered
Titles & IDs
Public title
Does mammary artery inflow improve graft patency in Coronary Artery Bypass ?
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Scientific title
Does mammary artery inflow affect long-term graft patency and freedom from cardiovascular death in patients undergoing Coronary Artery Bypass ?
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Secondary ID [1]
303412
0
Nil known
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Universal Trial Number (UTN)
U1111-1264-8409
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Coronary artery disease
320701
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Condition category
Condition code
Cardiovascular
318546
318546
0
0
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Coronary heart disease
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Surgery
318857
318857
0
0
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Surgical techniques
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A cardiac surgeon will perform 'on-pump' coronary artery bypass surgery for all patients, this procedure takes approximately 3-4.5 hours, . Patients undergoing isolated coronary artery bypass surgery are suitable. All patients included in the study (both intervention and control) will receive a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft. The intervention group will receive conduit inflow from the right internal mammary artery (RIMA) as an extension/composite graft to supply the largest "non-LAD" coronary territory. The procedure for patients in the intervention arm is expected to take approximately 15 minutes longer to permit harvesting a short segment of the right internal mammary artery (RIMA).
Adherence to protocol intervention will be determined through contemporaneous data entry by the treating team with control-checking by independent researcher audit of surgeons operative notes.
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Intervention code [1]
319715
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Treatment: Surgery
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Comparator / control treatment
Patients undergoing isolated 'on-pump' CABG will receive a conventional configuration of coronary artery bypass grafts with a LIMA-to-LAD and standard aorto-coronary anastomosis ('aortic top-end') as conduit inflow for the remaining grafts. The duration of coronary artery bypass surgery is 3-4.5 hours dependant on the number of grafts.
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Control group
Active
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Outcomes
Primary outcome [1]
326510
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Composite outcome of graft occlusion and freedom from cardiovascular death with IMA or aortic inflow.
Outcomes are to be assessed with telephone follow-up, medical record review and outcomes of pre-planned interval CT coronary angiography
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Assessment method [1]
326510
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Timepoint [1]
326510
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Patients will be followed up at 1 year, 5 years and 10 years with a telephone call and CT coronary angiography to be performed at these time points.
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Secondary outcome [1]
391728
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Freedom from major adverse cardiac and cerebrovascular events
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Assessment method [1]
391728
0
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Timepoint [1]
391728
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Patients will be followed up at 1 year, 5 years and 10 years with a telephone call and review of appropriate medical records.
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Eligibility
Key inclusion criteria
Adult patients undergoing isolated coronary artery bypass surgery
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Minimum age
40
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
< 40 years old
Non-English language speaking
Unable to consent for medical procedures unassisted
Contra-indication to either arm of the Protocol (e.g. porcelain aorta, previous saphenous vein ablation, mediastinal radiation etc)
Previous cardiac or thoracic surgery
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Sealed opaque letters
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using random computer generated sequence
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
Survival analysis performed with Kaplan-Meier plots and hazard ratios from Cox regression model
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
24/03/2021
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Actual
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Date of last participant enrolment
Anticipated
22/03/2022
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
140
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
18689
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Royal North Shore Hospital - St Leonards
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Recruitment postcode(s) [1]
33126
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2065 - St Leonards
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Funding & Sponsors
Funding source category [1]
307827
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Charities/Societies/Foundations
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Name [1]
307827
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Heart Research Australia
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Address [1]
307827
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Royal North Shore Hospital
Building 36
4 Westbourne Street
St Leonards NSW 2065
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Country [1]
307827
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Australia
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Primary sponsor type
Individual
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Name
Dr Levi Bassin
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Address
Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country
Australia
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Secondary sponsor category [1]
308536
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Individual
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Name [1]
308536
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Dr David Bell
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Address [1]
308536
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country [1]
308536
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Australia
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Secondary sponsor category [2]
308539
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Individual
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Name [2]
308539
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Dr Campbell Flynn
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Address [2]
308539
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country [2]
308539
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Australia
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Other collaborator category [1]
281650
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Individual
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Name [1]
281650
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Dr David Marshman
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Address [1]
281650
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country [1]
281650
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
307832
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Northern Sydney Local Health District HREC
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Ethics committee address [1]
307832
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Level 13 Kolling Building Royal North Shore Hospital 4 Westbourne Street St Leonards NSW 2065
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Ethics committee country [1]
307832
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Australia
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Date submitted for ethics approval [1]
307832
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19/09/2018
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Approval date [1]
307832
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08/10/2018
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Ethics approval number [1]
307832
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AU/1/B3A738
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Summary
Brief summary
The aim of this project is to investigate whether or not using the right internal mammary artery (rather than the ascending aorta) as a source of blood inflow for coronary artery bypass graft surgery (CABG) results in superior long term graft patency. CABG has been shown to be the most durable method of myocardial revascularisation. Efforts to further extend the long-term benefits of CABG have mainly focussed primarily on improving graft patency rates by using arterial grafts. Less attention has been paid to graft haemodynamics, particularly the source of graft inflow, and the role that this may play in prolonging graft patency. We know that high wall sheer stress leads to graft failure and we believe that gentler mammary artery inflow may encourage improved graft harm-dynamics and therefore patency. We plan to randomise patients undergoing CABG to standard practice (which involves using the ascending aorta as inflow) or to a composite graft group (using the right internal mammary artery as inflow) in order to assess whether or not graft inflow affects patency.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
108662
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Dr Levi Bassin
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Address
108662
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country
108662
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Australia
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Phone
108662
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+61 2 9449 1559
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Fax
108662
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Email
108662
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[email protected]
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Contact person for public queries
Name
108663
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Campbell Flynn
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Address
108663
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country
108663
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Australia
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Phone
108663
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+61 299267111
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Fax
108663
0
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Email
108663
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[email protected]
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Contact person for scientific queries
Name
108664
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Campbell Flynn
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Address
108664
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Royal North Shore Hospital
4 Westbourne Street
St Leonards NSW 2065
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Country
108664
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Australia
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Phone
108664
0
+61 299267111
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Fax
108664
0
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Email
108664
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Patient data not to be shared as per ethics committee approval stipulations
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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