Evaluation of the Superiority of VAsopressin Versus NOradrenaline in the Management of Patients at Risk of Kidney Failure Undergoing Cardiac Surgery With Extracorporeal Circulation

Study Overview
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Brief Summary
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This is a randomized, double blind, multicenter study following surgery with extracorporeal circulation to compare blood pressure optimization with vasopressin versus noradrenaline. It is planned to include 840 patients in order to have 420 patients with vasoplegic syndrome. The primary objective of this study is to determine whether the use of vasopressin to maintain blood pressure following cardiac surgery decreases the number of patients with acute renal failure and/or death compared with the usual use of norepinephrine. Participation in the study involves daily follow-up at D1, D2, and D7 of the onset of the syndrome and then follow-up at D30 and D90.

Official Title
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Prospective Randomized Double-blind Study Evaluating the Superiority of VAsopressin Versus NOradrenaline in the Management of Patients at Risk of Kidney Failure Undergoing Cardiac Surgery With Extracorporeal Circulation

Conditions
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Scheduled Cardiac Surgery With Extracorporeal Circulation, Vasoplegic Syndrome

Intervention / Treatment
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* Drug: Vasopressin
* Drug: Norepinephrine
* Other: Collection of clinical data
* Other: Quality of Life Questionnaire EQ-5D


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient who has given free, written and informed consent Patient of legal age. Negative pregnancy test for women of childbearing age Patient requiring cardiac surgery: Scheduled (> 24h) With extracorporeal circulation (ECC) Myocardial revascularization (coronary bypass), and/or surgical correction of valvulopathy (aortic, mitral, pulmonary, tricupsidian), and/or of the ascending aorta and/or removal of an intracardiac tumor, and/or closure of a PFO/ASD Patient with at least 3 risk factors for acute kidney failure including: age > 70 years, combined surgery (more than two procedures), common trunk lesion, preoperative anemia, chronic respiratory failure, obliterative arterial disease of the lower extremities, diabetes, glomerular filtration < 60 ml min-1 m², LVEF <40%, redux, intra-aortic counterpulsation balloon, expected duration of bypass surgery > 100 min, albuminuria Exclusion Criteria: Patient not affiliated to national health insurance or not beneficiary of a social security system, Patient subject to a measure of legal protection (curatorship, guardianship), Pregnant, parturient or breastfeeding women, Patients of legal age who are incapable or unable to express their consent, Patients who have already been included in this study Patients requiring emergency surgery (less than 24 hours) Patient with chronic kidney failure on dialysis, Patient with a cardiac transplant, Patient on left-sided monoventricular assistance, Patient on ECMO/ECLS, Patient with acute circulatory failure in the immediate preoperative period (sepsis, hemorrhage), Patients with known hypersensitivity to the active ingredient (argipressin) or to one of the excipients of REVERPLEG®. Secondary exclusion criteria: Patient not developing persistent arterial hypotension (vasoplegic syndrome), within 12 hours after completion of surgery, defined as persistent mean arterial pressure (MAP) <65 mmHg despite correction of preload and inotropism, with a cardiac index >2.2 l min-1 m-2, and not responding to 30 mg cumulative of ephedrine in bolus Patient with hemorrhagic shock perioperatively before receiving vasopressor therapy (treatment under study)

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br> | Drug: Vasopressin<br>* The infusion is started at 5 ml hr-1, increased in increments of 1 ml hr-1 every 5 minutes to reach a maximum target rate of 30 ml hr-1<br>Other: Collection of clinical data<br>* At D1, D2, D7, D30 or D60 and D90<br>Other: Quality of Life Questionnaire EQ-5D<br>* At the anesthesia consultation, discharge from intensive care, D7, D30 and D90<br>|
| Active Comparator: Control<br> | Drug: Norepinephrine<br>* The infusion is started at 5 ml h-1, increased in increments of 1 ml h-1 every 5 minutes to a maximum target rate of 30 ml h-1<br>Other: Collection of clinical data<br>* At D1, D2, D7, D30 or D60 and D90<br>Other: Quality of Life Questionnaire EQ-5D<br>* At the anesthesia consultation, discharge from intensive care, D7, D30 and D90<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of a renal complication or death |  | From the onset of the vasoplegic syndrome until 7 days after |