Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Michael J. Mack, Michael A. Acker, Annetine C. Gelijns, Jessica Overbey, Michael K. Parides, Jeffrey N. Browndyke, Mark A. Groh, Alan J. Moskowitz, Neal Jeffries, Gorav Ailawadi, Vinod H. Thourani, Ellen Moquete, Alexander Iribarne, Pierre Voisine, Louis P. Perrault, Michael E. Bowdish, Michel Bilello, Christos Davatzikos, Ralph Mangusan, Rachelle Winkle, Peter K. Smith, Robert E. Michler, Marissa A. Miller, Karen O’Sullivan, Wendy C. Taddei‐Peters, Eric A. Rose, Richard D. Weisel, Karen L. Furie, Emilia Bagiella, Claudia S. Moy, Patrick T. O’Gara, Steven R. Messé, for the Cardiothoracic Surgical Trials Network (CTSN)

JAMA · 2017

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Summary

This randomised controlled trial evaluated two cerebral embolic protection devices against standard cannulation in 383 patients undergoing surgical aortic valve replacement at 18 North American centres. Neither the suction-based extraction device nor the intra-aortic filtration device demonstrated significant reduction in CNS infarction or 30-day composite outcomes compared with control, with freedom from CNS infarction rates of 32.0% and 25.6% respectively versus 32.4% control.

UK applicability

Findings are directly applicable to UK cardiothoracic surgical practice, as aortic valve replacement is performed across NHS centres using similar techniques. Results may inform commissioning decisions regarding adoption of embolic protection devices in the UK National Health Service.

Key measures

Primary: freedom from CNS infarction at 7 days (±3 days). Secondary: 30-day composite of mortality/clinical ischaemic stroke/acute kidney injury; delirium; mortality; serious adverse events; neurocognition.

Outcomes reported

The study measured freedom from clinical or radiographic central nervous system (CNS) infarction at 7 days post-procedure, and composite outcomes including mortality, clinical ischaemic stroke, and acute kidney injury within 30 days. Secondary measures included delirium, mortality, serious adverse events, and neurocognitive function.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT
Source type
Peer-reviewed study
Status
Published
Geography
United States
System type
Human clinical
DOI
10.1001/jama.2017.9479
Catalogue ID
BFmor3gavd-sgh96u

Topic tags

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