Neuroprotection in Patients Undergoing Aortic Valve Replacement

NCT ID: NCT02389894

Last Updated: 2019-04-29

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

383 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-31

Study Completion Date

2017-01-31

Brief Summary

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To evaluate the efficacy and safety of embolic protection devices to reduce ischemic brain injury in patients undergoing surgical aortic valve replacement (AVR).

Detailed Description

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This is a multicenter randomized trial in which patients diagnosed with calcific aortic stenosis (AS) with planned AVR will be randomized to 1) the treatment arm of the Edwards Life Science filter and cannula or the filter as a stand alone with any cannula or 2) to the treatment arm of the CardioGard cannula versus 3) standard care in a 1:1:1 ratio.

Conditions

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Aortic Stenosis Brain Infarction Cerebrovascular Accident Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Embol-X Embolic Protection Device

The surgeon may use either the EMBOL-X® Access Device/Aortic Cannula or a standard cannula with the EMBOL-X® filter deployed through a separate introducer sheath.

Group Type ACTIVE_COMPARATOR

Embol-X Embolic Protection Device

Intervention Type DEVICE

per the manufacturer's instructions for use (IFU).

CardioGard Cannula

The Cardiogard embolic protection device is a curved tip 24-French aortic perfusion cannula.

Group Type ACTIVE_COMPARATOR

CardioGard Cannula

Intervention Type DEVICE

CardioGard Cannula, per the manufacturer's instructions for use (IFU).

Standard Cannula

Patients in this arm will receive the standard of care surgical procedure using a cannula of the surgeon's choosing.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Embol-X Embolic Protection Device

per the manufacturer's instructions for use (IFU).

Intervention Type DEVICE

CardioGard Cannula

CardioGard Cannula, per the manufacturer's instructions for use (IFU).

Intervention Type DEVICE

Other Intervention Names

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Edwards Embol-X embolic protection device CardioGard Emboli Protection Cannula

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 60 years
* Planned and scheduled surgical aortic valve replacement via a full or minimal-access sternotomy (using central aortic perfusion cannulae) for calcific aortic stenosis with a legally marketed valve
* No evidence of neurological impairment as defined by a NIHSS ≤1 and modified Rankin scale (mRS) ≤ 2 within 7 days prior to randomization
* Ability to provide informed consent and comply with the protocol

Exclusion Criteria

* Contraindication to legally marketed embolic protection devices (e.g. aneurysm of the ascending aorta, aortic trauma, porcelain aorta, known sensitivity to heparin)
* History of clinical stroke within 3 months prior to randomization
* Cardiac catheterization within 3 days of the planned aortic valve replacement
* Cerebral and or aortic arch arteriography or interventions within 3 days of the planned aortic valve replacement
* Active endocarditis at time of randomization
* Anticipated inability to tolerate or contraindication for MRI (e.g., known intolerance of MRI, permanent pacemaker at baseline or expected implantation of a permanent pacemaker)
* Any other concomitant aortic procedure such as root replacement
* Concomitant surgical procedures other than CABG, mitral annuloplasty, left atrial appendage (LAA) excision or exclusion, atrial septal defect (ASD) closure or patent foramen ovale (PFO) closure
* Clinical signs of cardiogenic shock or treatment with IV inotropic therapy prior to randomization
* Concurrent participation in an interventional (drug or device) trial
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Icahn School of Medicine at Mount Sinai

OTHER

Sponsor Role lead

Responsible Party

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Annetine Gelijns

Chair, Department of Population Health Science & Policy, Edmond A. Guggenheim Professor of Health Policy Co-Director, InCHOIR

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Annetine C Gelijns, PhD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Richard Weisel, MD

Role: STUDY_CHAIR

Toronto General Hospital

Locations

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University of Southern California

Los Angeles, California, United States

Site Status

Emory University

Atlanta, Georgia, United States

Site Status

University of Maryland

Baltimore, Maryland, United States

Site Status

NIH Heart Center at Suburban Hospital

Bethesda, Maryland, United States

Site Status

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Montefiore Einstein Heart Center

The Bronx, New York, United States

Site Status

Mission Hospital

Asheville, North Carolina, United States

Site Status

Duke University

Durham, North Carolina, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

Ohio State University

Columbus, Ohio, United States

Site Status

University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Baylor Research Institute

Plano, Texas, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

University of Alberta Hospital

Edmonton, Alberta, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status

Institut Universitaire de Cardiologie de Quebec (Hopital Laval)

Québec, Quebec, Canada

Site Status

Countries

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United States Canada

References

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Messe SR, Overbey JR, Thourani VH, Moskowitz AJ, Gelijns AC, Groh MA, Mack MJ, Ailawadi G, Furie KL, Southerland AM, James ML, Moy CS, Gupta L, Voisine P, Perrault LP, Bowdish ME, Gillinov AM, O'Gara PT, Ouzounian M, Whitson BA, Mullen JC, Miller MA, Gammie JS, Pan S, Erus G, Browndyke JN; Cardiothoracic Surgical Trials Network (CTSN) Investigators. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement. J Thorac Cardiovasc Surg. 2024 Feb;167(2):624-633.e4. doi: 10.1016/j.jtcvs.2022.01.053. Epub 2022 Mar 18.

Reference Type DERIVED
PMID: 35483981 (View on PubMed)

Crestanello JA. "Not in my brain": The use of embolic protection devices to prevent brain embolization during cardiovascular procedures. J Thorac Cardiovasc Surg. 2018 Dec;156(6):e205-e206. doi: 10.1016/j.jtcvs.2018.05.114. Epub 2018 Jun 23. No abstract available.

Reference Type DERIVED
PMID: 30007783 (View on PubMed)

Mack MJ, Acker MA, Gelijns AC, Overbey JR, Parides MK, Browndyke JN, Groh MA, Moskowitz AJ, Jeffries NO, Ailawadi G, Thourani VH, Moquete EG, Iribarne A, Voisine P, Perrault LP, Bowdish ME, Bilello M, Davatzikos C, Mangusan RF, Winkle RA, Smith PK, Michler RE, Miller MA, O'Sullivan KL, Taddei-Peters WC, Rose EA, Weisel RD, Furie KL, Bagiella E, Moy CS, O'Gara PT, Messe SR; Cardiothoracic Surgical Trials Network (CTSN). Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement: A Randomized Clinical Trial. JAMA. 2017 Aug 8;318(6):536-547. doi: 10.1001/jama.2017.9479.

Reference Type DERIVED
PMID: 28787505 (View on PubMed)

Other Identifiers

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2U01HL088942-07

Identifier Type: NIH

Identifier Source: secondary_id

View Link

GCO 08-1078-0009

Identifier Type: -

Identifier Source: org_study_id

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