Minimally Invasive Coronary Artery Bypass Supported by Cangrelor
MINOTAUR
1 other identifier
observational
30
1 country
1
Brief Summary
The purpose of this study is to find out whether it is safe and practical to perform MIDCAB surgery (a minimally invasive heart bypass procedure) while patients receive a continuous cangrelor infusion during the operation. Cangrelor is a medicine that helps prevent blood clots and works quickly through a vein drip. The study compares patients receiving cangrelor during surgery to patients who had the same surgery in the past while on aspirin, with or without cangrelor given beforehand. Study Question: Can MIDCAB surgery be safely performed under cangrelor infusion, without increasing the risk of bleeding or other complications? Hypothesis: Using cangrelor during MIDCAB surgery is safe and feasible, and it provides effective protection against blood clots during the procedure. This study will help doctors understand whether intraoperative cangrelor can improve patient safety and outcomes in minimally invasive heart surgery.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at below P25 for all trials
Started May 2024
Typical duration for all trials
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
May 12, 2024
CompletedFirst Submitted
Initial submission to the registry
March 25, 2026
CompletedFirst Posted
Study publicly available on registry
April 7, 2026
CompletedPrimary Completion
Last participant's last visit for primary outcome
January 1, 2028
ExpectedStudy Completion
Last participant's last visit for all outcomes
January 1, 2028
April 14, 2026
April 1, 2026
3.6 years
March 25, 2026
April 13, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Excessive CABG-related bleeding during and after MIDCAB surgery
Excessive bleeding is defined as the occurrence of at least one of the following: (1) bleeding requiring surgical re-exploration, (2) 24-hour chest tube output greater than 1 liter, or (3) transfusion of more than 4 units of packed red blood cells. This measure assesses the safety of cangrelor-guided MIDCAB compared with historical aspirin-treated controls.
From the start of surgery through 24 hours postoperatively
Secondary Outcomes (12)
In-hospital MACCE
From surgery through hospital discharge, an average of 8 days
Probable or Defined Stent Thrombosis
From surgery through hospital discharge, an average of 8 days
Cardiac Injury (High-Sensitivity Troponin)
Preoperative baseline until hospital discharge, an average of 10 days
Chest Tube Output
6, 12, 24, and 48 hours postoperatively
Blood Transfusion Requirements and Nadir Hemoglobin
From surgery through hospital discharge, an average of 8 days
- +7 more secondary outcomes
Other Outcomes (1)
Serious Adverse Events and Adverse Drug Reactions
From study inclusion through hospital discharge or resolution of ongoing events, an average of 10 days
Study Arms (2)
Cangrelor MIDCAB Group (Prospective Cases)
Patients prospectively enrolled to undergo MIDCAB surgery while receiving continuous cangrelor infusion at 0.75 μg/kg per minute. All prior oral antiplatelet therapy is discontinued, and platelet function is monitored daily with Multiplate® testing. Data collected include perioperative safety, bleeding outcomes, laboratory values, and clinical events.
Aspirin MIDCAB Group (Historical Controls)
Retrospective patients who previously underwent MIDCAB surgery under aspirin therapy, with or without prior bridging with cangrelor. Relevant perioperative and clinical data are extracted from the institutional database for comparison with the prospective cases.
Interventions
Cangrelor-guided MIDCAB surgery: Patients undergo minimally invasive direct coronary artery bypass (MIDCAB) with continuous intravenous cangrelor infusion at 0.75 μg/kg per minute. Prior oral antiplatelet therapy is discontinued, and platelet function is monitored daily using Multiplate® testing. Cangrelor infusion is started when platelet aggregation reaches predefined thresholds and continued throughout surgery until it is safe to restart oral antiplatelet therapy.
Aspirin MIDCAB surgery: Historical control patients underwent MIDCAB under aspirin therapy, with or without prior bridging with cangrelor. Perioperative management follows standard care, including anticoagulation with unfractionated heparin during surgery and routine monitoring of laboratory and clinical outcomes.
Eligibility Criteria
The study population includes adult patients scheduled for minimally invasive direct coronary artery bypass (MIDCAB) surgery at Cardiocentro Ticino Institute, Lugano, Switzerland. Patients will be selected for either prospective cangrelor-guided MIDCAB or retrospective historical control MIDCAB under aspirin therapy. The population includes individuals with multivessel coronary artery disease requiring LIMA-LAD bypass, regardless of sex or comorbidities, who meet all inclusion and no exclusion criteria. Patients with planned concomitant PCI are excluded. This population represents real-world candidates for MIDCAB surgery under antiplatelet management protocols.
You may qualify if:
- Age ≥18 years old
- CABG with IMA-LAD graft in MIDCAB technique
- Age ≥18 years old
- CABG with IMA-LAD graft in MIDCAB technique
- Signed informed consent
You may not qualify if:
- Administration of fibrinolytics or GP IIb/IIIa inhibitors
- Previous intracranial hemorrhage
- Known bleeding diathesis
- Patients undergoing concomitant PCI and MIDCAB
- Severe renal or liver disease
- Pregnancy or breast feeding
- Unconsciousness
- Known hypersensitivity to study drug (cangrelor)
- Recent administration of fibrinolytics or GP IIb/IIIa inhibitors
- Previous intracranial hemorrhage
- Known bleeding diathesis
- Patients undergoing concomitant PCI and MIDCAB
- Severe renal or liver disease
- Pregnancy or breast feeding
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Istituto Cardiocentro Ticino
Lugano, Ch/ti, 6900, Switzerland
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Marco Valgimigli, Prof. Dr. Med.
Cardiocentro Ticino
Central Study Contacts
Study Design
- Study Type
- observational
- Observational Model
- CASE CONTROL
- Time Perspective
- OTHER
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Cardiology Chief Prof. Dr. Med
Study Record Dates
First Submitted
March 25, 2026
First Posted
April 7, 2026
Study Start
May 12, 2024
Primary Completion (Estimated)
January 1, 2028
Study Completion (Estimated)
January 1, 2028
Last Updated
April 14, 2026
Record last verified: 2026-04