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Article

Hybrid approach for cerebral protection in open-heart surgery: Case series




doi: 10.1111/jocs.16725.


Online ahead of print.

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Ming Lau et al.


J Card Surg.


.

Abstract


Background:

Stroke remains one of the most important complications of cardiac surgery and occurs in 2.2% after open-heart procedure. It is associated with significant morbidity and mortality. The use of a cerebral protection system during transcatheter aortic valve implantation may be associated with a lower risk of periprocedural strokes, and mortality at 30 days. The aim of the present study was to assess the safety and feasibility of this device in patients at high risk for stroke during open cardiac surgery.


Methods:

We present six patients with a high risk of perioperative stroke who underwent placement of Sentinel cerebral protection system during various open-heart operations between 2018 and 2021.


Results:

The system was successfully deployed, and debris was retrieved in all patients. There was no device-related complication or development of ischemic stroke postoperatively. One patient suffered from intracranial hemorrhage due to peri-operative coagulopathy.


Conclusions:

We demonstrated the feasibility and safety of this hybrid approach with a high debris capture rate. It encourages further study to evaluate the benefits of the Sentinel cerebral protection system in reducing stroke and mortality in selected patients undergoing open-heart surgery.


Keywords:

Sentinel; cardiac surgical procedures; embolic protection devices; ischemic stroke.

References

REFERENCES

    1. Gaudino M, Rahouma M, Di Mauro M, et al. Early versus delayed stroke after cardiac surgery: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8:e012447.

    1. Ndunda PM, Vindhyala MR, Muutua TM, Fanari Z. Clinical outcomes of sentinel cerebral protection system use during transcatheter aortic valve replacement: a systematic review and meta-analysis. Cardiovasc Revasc Med. 2020;21(6):717-722.

    1. Mack MJ, Acker MA, Gelijns AC, et al. Effect of cerebral embolic protection devices on CNS infarction in surgical aortic valve replacement a randomized clinical trial. JAMA. 2017;318(6):536-547.

    1. Claret Medical. Claret Medical receives FDA clearance to market Sentinel Cerebral Protection System in the U.S. 2017. http://www.claretmedical.com/pdf/news/FDA%20Approval.pdf

    1. Ho JYK, Chan JWY, Chow SCY, et al. Application of cerebral protection system in open mitral replacement with extensive calcified left atrial thrombus. Innovations. 2020;15(1):85-87.



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