New Paper Focuses on Safety and Efficacy of ASD Closure Devices
As follow-up to the U.S. Food and Drug Administration's (FDA's) Circulatory System Devices Panel meeting last year, a white paper published May 20 in JACC: Cardiovascular Interventions looks at the current safety and efficacy of atrial septal defect (ASD) devices, including cardiac perforation or erosion, and proposes using the NCDR's IMPACT Registry® for more comprehensive post-market evaluation and monitoring of devices.
In light of the insufficient evidence and lack of consensus around how or if to change clinical practice or labeling of ACS occlusion devices, the FDA's Circulatory System Devices Panel hosted a hearing last year focused on the need to further define the risk factors and incidence of erosion by the ASO. The ACC provided both a written statement and oral testimony as part of the hearing. Coming out of the hearing, the FDA panel noted that additional clinical trials are unlikely to better define the incidence of erosion. Instead, panel members recommended a case-cohort study design focused on identifying critical risk factors.
According to the white paper authors, the FDA panel's recommendation "has merit only if the cases identified for study have high quality, comprehensive, and longitudinal clinical data and imaging available." According to the authors, the NCDR's IMPACT Registry given its size and sophistication is one tool that might be suitable for this task. The authors note that the number of centers enrolled in IMPACT is growing steadily, with the goal of enrolling the majority of the 200 centers in the U.S. by the end of 2013. While current IMPACT Registry data elements for the ASD occlusion are not sufficient the provide additional information about risk factors, the authors suggest the overarching goal of the Registry to develop longitudinal modules to study longer-term outcomes for select information "is perfectly aligned with the FDA panel recommendations."
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