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DEFLECT I: Keystone Heart Embolic Deflection Trial

Primary Purpose

Aortic Stenosis

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Keystone Heart Embolic Deflection Device
Sponsored by
Keystone Heart
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Aortic Stenosis focused on measuring TAVR

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. The patient must be ≥18 years of age.
  2. Patient meets indications for TAVR procedure.
  3. The patient is willing to comply with protocol-specified follow-up evaluations.
  4. The patient, or legally authorized representative, has been informed of the nature of the study, agrees to its provisions and has provided written informed consent, approved by the appropriate Medical Ethics Committee or Institutional Review Board.

Exclusion Criteria:

  1. Patients undergoing TAVR via the trans-axillary, subclavian, or direct aortic route
  2. Pregnant or nursing subjects and those who plan pregnancy in the period up to 1 year following index procedure. Female subjects of child-bearing potential must have a negative pregnancy test done within 7 days prior to index procedure per site standard test.
  3. Patients with known diagnosis of acute myocardial infarction (AMI) within 72 hours preceding the index procedure (according to definition) or AMI >72 hours preceding the index procedure, in whom creatine kinase and creatine kinase have not returned to within normal limits at the time of procedure.
  4. Patients who are currently experiencing clinical symptoms consistent with new onset AMI, such as nitrate-unresponsive prolonged chest pain.
  5. Patients with impaired renal function (estimated Glomerular Filtration Rate [estimated Glomerular Filtration Rate] <30, calculated from serum creatinine by the Cockcroft-Gault formula)
  6. Patients with a platelet count of <100.000 cells/mm³ or > 700.000 cells/mm³ or a white blood cell < 3000 cells/mm³ within 7 days prior to index procedure.
  7. Patients with a history of bleeding diathesis or coagulopathy or patients in whom anti-platelet and/or anticoagulant therapy is contraindicated, or who will refuse transfusion.
  8. Patients who have received any organ transplant or are on a waiting list for any organ transplant.
  9. Patients with known other medical illness or known history of substance abuse that may cause non-compliance with the protocol, confound the data interpretation or is associated with a life expectancy of less than one year.
  10. Patients with known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, clopidogrel/ticlopidine, nitinol, stainless steel alloy, and/or contrast sensitivity that cannot be adequately pre-medicated.
  11. Patients with a history of a stroke or transient ischemic attack (TIA) within the prior 6 months.
  12. Patients with an active peptic ulcer or history of upper gastrointestinal (GI) bleeding within the prior 6 months.
  13. Patients presenting with cardiogenic shock.
  14. Patients with severe peripheral arterial disease that precludes 9 French sheath vascular access.
  15. Patients with documented friable or mobile atherosclerotic plaque in the aortic arch.
  16. Patients with contraindication to cerebral MRI.
  17. Patients who have a planned treatment with any other investigational device or procedure during the study period

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Keystone Heart Embolic Deflection Device

    Arm Description

    Protected Transcatheter Aortic Valve Replacement

    Outcomes

    Primary Outcome Measures

    Number of Patients Where the Device Accessed, Deployed and Was Positioned in the Aortic Arch (Device Performance)
    Device ability to access and deploy in the aortic arch and position the device to cover all three vessels.
    Number of Serious Adverse Events Related to Investigational Device and Procedure
    Incidence of investigational device- and investigational procedure-related serious adverse events

    Secondary Outcome Measures

    Full Information

    First Posted
    September 20, 2011
    Last Updated
    August 24, 2020
    Sponsor
    Keystone Heart
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01448421
    Brief Title
    DEFLECT I: Keystone Heart Embolic Deflection Trial
    Official Title
    A Prospective, Single Arm Feasibility Study to Evaluate the Safety and Performance of the Keystone Heart Embolic Deflection Device in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2014
    Overall Recruitment Status
    Completed
    Study Start Date
    March 2012 (undefined)
    Primary Completion Date
    June 2013 (Actual)
    Study Completion Date
    January 2014 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Keystone Heart

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a research study using the Keystone Heart Embolic Deflection Device and involving patients with aortic stenosis (a disease of the aortic valve), to be treated with Transcatheter Aortic Valve Replacement (TAVR). The TAVR procedure consists in replacing the diseased aortic valve by a new artificial valve. The new valve is put into place using a long, thin tube called a catheter that is inserted into a small incision (cut) in the patient's groin and threaded through his/her arteries up to the heart.
    Detailed Description
    This is a research study using the Keystone Heart Embolic Deflection Device and involving patients with aortic stenosis (a disease of the aortic valve), to be treated with Transcatheter Aortic Valve Replacement (TAVR). The TAVR procedure consists in replacing the diseased aortic valve by a new artificial valve. The new valve is put into place using a long, thin tube called a catheter that is inserted into a small incision (cut) in the patient's groin and threaded through his/her arteries up to the heart. During the TAVR procedure, there is a risk that an abnormal particle (called embolism) could break off from inside the arteries and travel to the brain. The embolism could be made of clumps of blood (clots), air, part of your body tissue, or part of a medical device. If the embolism is carried through the blood to the brain, it could cause a stroke or other neurological (brain) problems. A stroke happens when blood flow to a part of the brain is blocked, causing brain cells to die. The Keystone Heart Embolic Deflection Device has been developed to prevent an embolism from going to the brain and causing a stroke or other brain damage. The device is a wire mesh filter that covers the vessels that carry blood to brain, deflecting any any blood clots or other materials away from the patient's brain and towards the lower body, where they are less likely to cause harm.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Aortic Stenosis
    Keywords
    TAVR

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    37 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Keystone Heart Embolic Deflection Device
    Arm Type
    Experimental
    Arm Description
    Protected Transcatheter Aortic Valve Replacement
    Intervention Type
    Device
    Intervention Name(s)
    Keystone Heart Embolic Deflection Device
    Intervention Description
    The Keystone Heart Embolic Deflection Device is used in the aortic arch to deflect and to reduce embolic material (debris/thrombus) to the cerebral/carotid arteries during endovascular procedures.
    Primary Outcome Measure Information:
    Title
    Number of Patients Where the Device Accessed, Deployed and Was Positioned in the Aortic Arch (Device Performance)
    Description
    Device ability to access and deploy in the aortic arch and position the device to cover all three vessels.
    Time Frame
    During the procedure
    Title
    Number of Serious Adverse Events Related to Investigational Device and Procedure
    Description
    Incidence of investigational device- and investigational procedure-related serious adverse events
    Time Frame
    30 days follow-up

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: The patient must be ≥18 years of age. Patient meets indications for TAVR procedure. The patient is willing to comply with protocol-specified follow-up evaluations. The patient, or legally authorized representative, has been informed of the nature of the study, agrees to its provisions and has provided written informed consent, approved by the appropriate Medical Ethics Committee or Institutional Review Board. Exclusion Criteria: Patients undergoing TAVR via the trans-axillary, subclavian, or direct aortic route Pregnant or nursing subjects and those who plan pregnancy in the period up to 1 year following index procedure. Female subjects of child-bearing potential must have a negative pregnancy test done within 7 days prior to index procedure per site standard test. Patients with known diagnosis of acute myocardial infarction (AMI) within 72 hours preceding the index procedure (according to definition) or AMI >72 hours preceding the index procedure, in whom creatine kinase and creatine kinase have not returned to within normal limits at the time of procedure. Patients who are currently experiencing clinical symptoms consistent with new onset AMI, such as nitrate-unresponsive prolonged chest pain. Patients with impaired renal function (estimated Glomerular Filtration Rate [estimated Glomerular Filtration Rate] <30, calculated from serum creatinine by the Cockcroft-Gault formula) Patients with a platelet count of <100.000 cells/mm³ or > 700.000 cells/mm³ or a white blood cell < 3000 cells/mm³ within 7 days prior to index procedure. Patients with a history of bleeding diathesis or coagulopathy or patients in whom anti-platelet and/or anticoagulant therapy is contraindicated, or who will refuse transfusion. Patients who have received any organ transplant or are on a waiting list for any organ transplant. Patients with known other medical illness or known history of substance abuse that may cause non-compliance with the protocol, confound the data interpretation or is associated with a life expectancy of less than one year. Patients with known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, clopidogrel/ticlopidine, nitinol, stainless steel alloy, and/or contrast sensitivity that cannot be adequately pre-medicated. Patients with a history of a stroke or transient ischemic attack (TIA) within the prior 6 months. Patients with an active peptic ulcer or history of upper gastrointestinal (GI) bleeding within the prior 6 months. Patients presenting with cardiogenic shock. Patients with severe peripheral arterial disease that precludes 9 French sheath vascular access. Patients with documented friable or mobile atherosclerotic plaque in the aortic arch. Patients with contraindication to cerebral MRI. Patients who have a planned treatment with any other investigational device or procedure during the study period
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Michael Mullen, Md.
    Organizational Affiliation
    The Heart Hospital, London, UK
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    25868876
    Citation
    Baumbach A, Mullen M, Brickman AM, Aggarwal SK, Pietras CG, Forrest JK, Hildick-Smith D, Meller SM, Gambone L, den Heijer P, Margolis P, Voros S, Lansky AJ. Safety and performance of a novel embolic deflection device in patients undergoing transcatheter aortic valve replacement: results from the DEFLECT I study. EuroIntervention. 2015 May;11(1):75-84. doi: 10.4244/EIJY15M04_01.
    Results Reference
    derived

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    DEFLECT I: Keystone Heart Embolic Deflection Trial

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