CTSN Embolic Protection Trial

This is a prospective, multicenter, randomized controlled clinical trial that will evaluate the effectiveness and safety of the CardioGard embolic protection cannula compared to a standard cannula. The enrollment period is expected to last 30 months, and all patients will be followed for 12 months post procedure.

RANDOMIZATION Patients will be randomized 1:1 to the embolic protection device or to a standard cannula in the operating room (OR) immediately after sternotomy and confirmation by the surgical team of the patient's suitability for the proposed intervention (CardioGard embolic protection device). Randomization will be with equal allocation and stratified by site and by procedure (i.e., isolated valve surgery or combined procedures, such as double valve or valve plus coronary artery bypass grafting, CABG). The randomization assignment will be controlled centrally and performed through a web-based data collection system that automates the delivery of the randomization codes. From the point of treatment assignment, primary efficacy will be analyzed by intention-to-treat; that is, the patients will be grouped by their assignments at randomization regardless of whether or not they actually received the treatment to which they were assigned.

STUDY POPULATION The patient population for this trial consists of patients age ≥ 60 undergoing different types of valve surgery with or without CABG via full or minimal-access sternotomy using legally marketed valve(s). Specific inclusion and exclusion criteria are listed below. All patients who meet the eligibility criteria may be included in the study regardless of gender, race, or ethnicity.

SUBSTUDY Sleep Disturbance Ancillary Sub-Study - Patients undergoing surgery for valvular heart disease (VHD) are at high risk for adverse events, including high rates of post-operative delirium (POD). Should circadian disruption be found to be an important predictor in this high-risk population, safe, low cost, and easy to administer therapies to regulate circadian rhythm such as light therapy could be evaluated in future studies

The aims of this ancillary sub-study include:

1. To investigate the association between short sleep duration, less sleep regularity, and greater circadian rhythm disruption prior to surgery and POD within 7 days of VHD surgery. 2. To investigate the association between short sleep duration, less sleep regularity and greater circadian rhythm disruption (reduced melatonin and cortisol amplitudes) after surgery and POD within 7 days of VHD surgery.

Approximately 300 EMPRO trial participants will be enrolled into the ancillary study. The study is being conducted in highly experienced clinical centers in the U.S. and Canada. The estimated enrollment period is 12-15 months.

All eligible and consented patients in the parent EMPRO trial will be offered enrollment in this ancillary study through the parent trial consent process.

• Proportion of patients who experience a clinical ischemic stroke [Срок оценки: within 3 days post-randomization]
• Proportion of patients who experience a clinical ischemic stroke [Срок оценки: within 7 days post-randomization]
• Number of patients with disabling clinical stroke [Срок оценки: within 3 days post-randomization]
• Number of patients with disabling clinical stroke [Срок оценки: within 7 days post-randomization]
• Neurological outcomes assessed by National Institutes of Health Stroke Scale (NIHSS) [Срок оценки: within 3 days post-randomization]
• Neurological outcomes assessed by National Institutes of Health Stroke Scale (NIHSS) [Срок оценки: within 7 days post-randomization]
• Number of patients with disabling clinical stroke determined by modified Rankin Scale (mRS) score ≥2 [Срок оценки: at baseline]
• Number of patients with disabling clinical stroke determined by modified Rankin Scale (mRS) score ≥2 [Срок оценки: at 30 days]
• Number of patients with disabling clinical stroke determined by modified Rankin Scale (mRS) score ≥2 [Срок оценки: at 90 days]
• Montreal Cognitive Assessment (MoCA) Score [Срок оценки: at baseline]
• Montreal Cognitive Assessment (MoCA) Score [Срок оценки: at 90 days]
• Montreal Cognitive Assessment (MoCA) Score [Срок оценки: at 12 months]