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Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis. (SCOPE I)

Primary Purpose

Aortic Valve Stenosis

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Symetis ACURATE neo/TF transfemoral TAVI system
Edwards Sapien 3 Transcatheter Heart Valve
Sponsored by
Insel Gruppe AG, University Hospital Bern
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Aortic Valve Stenosis focused on measuring Aortic valve stenosis, Transcatheter aortic valve implantation, Transcatheter aortic valve replacement, Randomized controlled trial

Eligibility Criteria

75 Years - undefined (Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient with severe aortic stenosis defined by an aortic valve area (AVA) < 1cm2 or AVA indexed to body surface area (BSA) of < 0.6 cm2/m2, including low-flow severe aortic stenosis defined by stroke volume index (SVI) < 35ml/m2, as assessed by integration of echocardiographic and invasive measurements
  • Subject is symptomatic (heart failure symptoms with New York Heart Association (NYHA) Functional Class > I, angina or syncope)
  • Patient is considered at increased risk for mortality if undergoing conventional surgical aortic valve replacement or judged as not operable as determined either

    • by a Logistic EuroSCORE > 20 % OR
    • by a STS-PROM score > 10% OR
    • by the heart team consisting of at least one cardiologist and cardiac surgeon based on the integration of individual clinical and anatomical factors not captured by risk-scores, the patient's age, frailty and life-expectancy
  • The heart team agrees on eligibility of the patient for participation and that TAVI by transfemoral access constitutes the most appropriate treatment modality, from which the patient will likely benefit most
  • Aortic annulus dimensions suitable for both valve types (area range: 338-573 mm2 AND perimeter range: 66-85 mm) based on ECG-gated multislice computed tomographic measurements. Findings of transesophageal echocardiography (TEE) and conventional aortography should be integrated in the anatomic assessment if available
  • Arterial aorto-iliac-femoral axis suitable for transfemoral access with a minimum access vessel diameter ≥ 6 mm as assessed by multislice computed tomographic angiography and/or conventional angiography
  • Written informed consent of the patient or her/his legal representative
  • Patient understands the purpose, the potential risks as well as benefits of the trial and is willing to participate in all parts of the follow-up

Exclusion Criteria:

  • Non-valvular aortic stenosis
  • Congenital aortic stenosis or unicuspid or bicuspid aortic valve
  • Non-calcific acquired aortic stenosis
  • Anatomy not appropriate for transfemoral transcatheter aortic valve implantation due to size of the aortic annulus or degree or eccentricity of calcification of the native aortic valve or tortuosity of the aorta or ilio-femoral arteries
  • Emergency procedure including patients in cardiogenic shock (low cardiac output, vasopressor dependence, mechanical hemodynamic support)
  • Severely reduced left ventricular (LV) function (ejection fraction < 20%)
  • Pre-existing prosthetic heart valve in aortic position
  • Presence of mitral valve prosthesis
  • Concomitant planned procedure except for percutaneous coronary intervention (PCI)
  • Planned non-cardiac surgery within 30 days
  • Stroke within 30 days of the procedure.
  • Myocardial infarction within 30 days of the procedure (except type 2)
  • Evidence of intra-cardiac mass, thrombus or vegetation
  • Severe coagulation conditions
  • Inability to tolerate anticoagulation/anti-platelet therapy
  • Active bacterial endocarditis or other active infections
  • Hypertrophic cardiomyopathy with or without obstruction
  • Contraindication to contrast media or allergy to nitinol
  • Participation in another trial, which would lead to deviations in the preparation or performance of the intervention or the post-implantation management from this protocol

Sites / Locations

  • Herz- und Gefäss-Klinik GmbH Bad Neustadt
  • Klinkum Augsburg
  • Zentralklinik Bad Berka
  • Herz- und Gefässzentrum Bad Beversen
  • Kerckhoff-Klinik
  • St.-Johannes-Hospital
  • Herzzentrum Dresden
  • Universitäres Herzzentrum Hamburg GmbH
  • Städtisches Klinikum Karlsruhe
  • ViDia Kliniken
  • Klinik für Herzchirurgie Karlsruhe
  • Herzzentrum Uniklinik Köln
  • Herzzentrum Leipzig
  • Deutsches Herzzentrum München
  • Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie
  • University Medical Center Utrecht
  • Bern University Hospital
  • Luzerner Kantonsspital
  • Universitätsspital Zürich
  • St Thomas' Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Symetis ACURATE neo/TF transfemoral TAVI system

Edwards Sapien 3 Transcatheter Heart Valve

Arm Description

Symetis ACURATE neo/TF transfemoral TAVI system: self-expandable transcatheter aortic bioprosthesis, support frame made of nitinol, supra-annular processed trileaflet porcine pericardial valve and an outer skirt to mitigate paravalvular regurgitation (manufactured by Symetis SA, Ecublens, Switzerland)

Edwards SAPIEN 3 Transcatheter Heart Valve system: balloon-expandable transcatheter aortic bioprosthesis, support frame made of cobalt-chromium, three leaflets constructed of processed bovine pericardial tissue and an outer polyethylene terephthalate (PET) sealing cuff to mitigate paravalvular regurgitation (manufactured by Edwards Lifesciences, Inc., Irvine, California, USA)

Outcomes

Primary Outcome Measures

Modified* combined early safety and clinical efficacy as defined by the Valve Academic Research Consortium-2 (VARC-2)
(* "NYHA class III or IV" is omitted due to lack of objectiveness in its ascertainment) All-cause mortality All stroke (disabling and non-disabling) Life-threatening or disabling bleeding Acute kidney injury (stage 2 or 3, including renal replacement therapy) Coronary artery obstruction requiring intervention Major vascular complication Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention) Rehospitalization for valve-related symptoms or worsening congestive heart failure Valve-related dysfunction: prosthetic aortic valve stenosis (mean gradient ≥ 20 mmHg, effective orifice area ≤ 0.9-1.1cm2 and/or Doppler velocity index < 0.35) AND/OR ≥ moderate prosthetic valve regurgitation)

Secondary Outcome Measures

Device success
Combined endpoint composed of: Absence of procedural mortality AND Correct positioning of a single prosthetic heart valve into the proper anatomical location AND Intended performance of the prosthetic heart valve (no prosthesis-patient mismatch and mean aortic valve gradient < 20 mmHg or peak velocity < 3 m/s, AND no moderate or severe prosthetic valve regurgitation)
Early safety
Combined endpoint composed of: All-cause mortality All stroke (disabling and non-disabling) Life-threatening or disabling bleeding Acute kidney injury - stage 2 or 3 (including renal replacement therapy) Coronary artery obstruction requiring intervention Major vascular complication Valve-related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI, or SAVR)
Clinical efficacy
Combined endpoint composed of: All-cause mortality All stroke (disabling and non-disabling) Requiring hospitalizations for valve-related symptoms or worsening congestive heart failure NYHA class III or IV Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, effective orifice area (EOA) ≤ 0.9-1.1 cm2 and/or Doppler velocity index (DVI) < 0. 35 m/s, AND/OR moderate or severe prosthetic valve regurgitation)
Time-related valve safety
Combined endpoint composed of: Structural valve deterioration (Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1 cm2 (depending on body surface area (BSA)) and/or DVI < 0.35 m/s AND/OR moderate or severe prosthetic valve regurgitation)) OR Requiring repeat procedure (TAVI or SAVR) Prosthetic valve endocarditis Prosthetic valve thrombosis Thrombo-embolic events (e.g. stroke) VARC bleeding, unless clearly unrelated to valve therapy (e.g. trauma)
All-cause mortality
All stroke (disabling and non-disabling)
Life-threatening or disabling bleeding
Fatal bleeding (Bleeding Academic Research Consortium (BARC) type 5)OR Bleeding in a critical organ, such as intracranial, intraspinal, intraocular, or pericardial necessitating pericardiocentesis, or intramuscular with compartment syndrome (BARC type 3b and 3c) OR Bleeding causing hypovolaemic shock or severe hypotension requiring vasopressors or surgery (BARC type 3b) OR Overt source of bleeding with drop in haemoglobin ≥5 g/dL or whole blood or packed red blood cells (RBCs) transfusion ≥4 units (BARC type 3b)
Acute kidney injury (stage 2 or 3, including renal replacement therapy)
Stage 2: Increase in serum creatinine to 200-299% (2.0-2.99 × increase compared with baseline) OR Urine output <0.5 mL/kg/h for >12 but <24 h Stage 3: Increase in serum creatinine to ≥300% (>3 × increase compared with baseline) OR serum creatinine of ≥4.0 mg/dL (≥354 mmol/L) with an acute increase of at least 0.5 mg/dL (44 mmol/L) OR Urine output <0.3 ml/kg/h for ≥24 h OR Anuria for ≥12 h Notes: The increase in creatinine must occur within 48 h. Patients receiving renal replacement therapy are considered to meet Stage 3 criteria irrespective of other criteria.
Coronary artery obstruction requiring intervention
Major vascular complication
Aortic dissection, aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudo-aneurysm OR Access-related vascular injury (dissection, stenosis, perforation, rupture, arterio-venous fistula, pseudoaneurysm, haematoma, irreversible nerve injury, compartment syndrome, percutaneous closure device failure) leading to death, life-threatening or major bleeding, visceral ischaemia, or neurological impairment OR Distal embolization (non-cerebral) from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage OR Use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischaemia or neurological impairment OR Any new ipsilateral lower extremity ischaemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower extremity angiogram OR Surgery for access site-related nerve injury OR Permanent access site-related nerve injury
Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention)
Rehospitalization for valve-related symptoms or worsening congestive heart failure
Valve-related dysfunction: prosthetic aortic valve stenosis AND/OR ≥ moderate prosthetic valve regurgitation
Prosthetic aortic valve stenosis: mean gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1cm2 and/or DVI < 0.35)
Conversion to open heart surgery
Annular rupture
New pacemaker implantation
Valve thrombosis
Any thrombus attached to or near an implanted valve that occludes part of the blood flow path, interferes with valve function, or is sufficiently large to warrant treatment. Note that valve-associated thrombus identified at autopsy in a patient whose cause of death was not valve-related should not be reported as valve thrombosis.
Mean trans-prosthetic aortic gradient
Aortic regurgitation
Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score

Full Information

First Posted
January 2, 2017
Last Updated
March 9, 2022
Sponsor
Insel Gruppe AG, University Hospital Bern
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1. Study Identification

Unique Protocol Identification Number
NCT03011346
Brief Title
Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis.
Acronym
SCOPE I
Official Title
Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
February 8, 2017 (Actual)
Primary Completion Date
May 2, 2019 (Actual)
Study Completion Date
February 16, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Insel Gruppe AG, University Hospital Bern

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). Many novel devices are currently being developed and established transcatheter heart valves undergo design reiterations to address limitations and reduce complication rates associated with the device and implantation procedure. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves. The aim of this study is to assess non-inferiority of the self-expandable Symetis ACURATE neo/TF in comparison to the balloon-expandable Edwards SAPIEN 3 transcatheter aortic valve bioprosthesis with regard to early safety and clinical efficacy at 30 days.
Detailed Description
Background: Transcatheter aortic valve implantation (TAVI) is an established and valuable treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). The use of TAVI is rapidly expanding worldwide and the indications for TAVI are widening into lower risk populations in view of favorable outcomes among high and intermediate risk patients. Many novel devices are currently developed or established devices undergo design reiterations to address limitations, such as vascular access complications, paravalvular regurgitation, and atrio-ventricular conductance disturbances. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves. The Symetis ACURATE neo/TF, a self-expandable transcatheter valve delivered via transfemoral access, gained Conformité Européenne (CE) marking in September 2014 after showing favorable procedural and short term results. The SCOPE I trial will compare its performance to the balloon-expandable Edwards SAPIEN 3, a widely used and well-established transcatheter heart valve of the second generation, in a randomized fashion. Objectives: The primary objective is the comparison of the Symetis ACURATE neo/TF to the Edwards SAPIEN 3 transcatheter aortic bioprosthesis with regard to early safety and clinical efficacy at 30 days. Secondary objectives involve the comparison between the two devices with regard to secondary clinical and echocardiographic endpoints at 30 days, 1 year and 3 years. Methods: Sample Size: Based on an anticipated incidence proportion of 22% for the primary non-hierarchical composite endpoint at 30 days in both treatment arms, a non-inferiority margin of 7.7%, a power of 80%, a one-tailed significance level of α = 0.05, and a low attrition rate, the total required sample size amounts to 730 patients. Design: Patients will be allocated to the Symetis ACURATE neo/TF or the Edwards SAPIEN 3 bioprosthesis at a 1:1 ratio by means of a randomly permuted block randomisation stratified on study center and Society of Thoracic Surgeons' predicted risk of mortality score (STS-PROM) strata (< 3%, ≥ 3 to < 8%, ≥ 8%). Analysis: Estimates of the risk-differences between the two treatment arms with regard to the primary endpoint will be pooled over the predefined STS-PROM strata by means of the Cochran-Mantel-Haenszel method and Wald-type confidence limits will be calculated using the Sato variance estimator. The non-inferiority assumption will be tested at a one-sided significance level with a type I error rate (α) = 0.05. The analysis of the primary composite endpoint will be conducted according to the intention-to-treat (ITT) and the per protocol (PP) principle and non-inferiority should be claimed only if met by both. In case non-inferiority is established, a superiority analysis will be performed using a two-tailed significance level with a type I error rate of α = 0.05. Further secondary analyses will evaluate between group differences in relation to demographic, clinical, procedural, functional and imaging characteristics. Pre-specified subgroup analyses will be conducted by use of appropriate interaction tests contrasting categories of sex, STS-PROM score (< 3%, ≥ 3 to < 8%, ≥ 8%), left ventricular ejection fraction (< 50% vs. ≥ 50%), and native aortic valve eccentricity index (≤ 0.25 vs. > 0.25).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Aortic Valve Stenosis
Keywords
Aortic valve stenosis, Transcatheter aortic valve implantation, Transcatheter aortic valve replacement, Randomized controlled trial

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
739 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Symetis ACURATE neo/TF transfemoral TAVI system
Arm Type
Active Comparator
Arm Description
Symetis ACURATE neo/TF transfemoral TAVI system: self-expandable transcatheter aortic bioprosthesis, support frame made of nitinol, supra-annular processed trileaflet porcine pericardial valve and an outer skirt to mitigate paravalvular regurgitation (manufactured by Symetis SA, Ecublens, Switzerland)
Arm Title
Edwards Sapien 3 Transcatheter Heart Valve
Arm Type
Active Comparator
Arm Description
Edwards SAPIEN 3 Transcatheter Heart Valve system: balloon-expandable transcatheter aortic bioprosthesis, support frame made of cobalt-chromium, three leaflets constructed of processed bovine pericardial tissue and an outer polyethylene terephthalate (PET) sealing cuff to mitigate paravalvular regurgitation (manufactured by Edwards Lifesciences, Inc., Irvine, California, USA)
Intervention Type
Device
Intervention Name(s)
Symetis ACURATE neo/TF transfemoral TAVI system
Intervention Description
Transcatheter aortic valve implantation of a Symetis ACURATE neo/TF bioprosthesis by transfemoral access, pre-dilatation mandatory.
Intervention Type
Device
Intervention Name(s)
Edwards Sapien 3 Transcatheter Heart Valve
Intervention Description
Transcatheter aortic valve implantation of an Edwards Sapien 3 bioprosthesis by transfemoral access.
Primary Outcome Measure Information:
Title
Modified* combined early safety and clinical efficacy as defined by the Valve Academic Research Consortium-2 (VARC-2)
Description
(* "NYHA class III or IV" is omitted due to lack of objectiveness in its ascertainment) All-cause mortality All stroke (disabling and non-disabling) Life-threatening or disabling bleeding Acute kidney injury (stage 2 or 3, including renal replacement therapy) Coronary artery obstruction requiring intervention Major vascular complication Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention) Rehospitalization for valve-related symptoms or worsening congestive heart failure Valve-related dysfunction: prosthetic aortic valve stenosis (mean gradient ≥ 20 mmHg, effective orifice area ≤ 0.9-1.1cm2 and/or Doppler velocity index < 0.35) AND/OR ≥ moderate prosthetic valve regurgitation)
Time Frame
30 days
Secondary Outcome Measure Information:
Title
Device success
Description
Combined endpoint composed of: Absence of procedural mortality AND Correct positioning of a single prosthetic heart valve into the proper anatomical location AND Intended performance of the prosthetic heart valve (no prosthesis-patient mismatch and mean aortic valve gradient < 20 mmHg or peak velocity < 3 m/s, AND no moderate or severe prosthetic valve regurgitation)
Time Frame
30 days
Title
Early safety
Description
Combined endpoint composed of: All-cause mortality All stroke (disabling and non-disabling) Life-threatening or disabling bleeding Acute kidney injury - stage 2 or 3 (including renal replacement therapy) Coronary artery obstruction requiring intervention Major vascular complication Valve-related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI, or SAVR)
Time Frame
30 days
Title
Clinical efficacy
Description
Combined endpoint composed of: All-cause mortality All stroke (disabling and non-disabling) Requiring hospitalizations for valve-related symptoms or worsening congestive heart failure NYHA class III or IV Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, effective orifice area (EOA) ≤ 0.9-1.1 cm2 and/or Doppler velocity index (DVI) < 0. 35 m/s, AND/OR moderate or severe prosthetic valve regurgitation)
Time Frame
30 days
Title
Time-related valve safety
Description
Combined endpoint composed of: Structural valve deterioration (Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1 cm2 (depending on body surface area (BSA)) and/or DVI < 0.35 m/s AND/OR moderate or severe prosthetic valve regurgitation)) OR Requiring repeat procedure (TAVI or SAVR) Prosthetic valve endocarditis Prosthetic valve thrombosis Thrombo-embolic events (e.g. stroke) VARC bleeding, unless clearly unrelated to valve therapy (e.g. trauma)
Time Frame
30 days, 1 year
Title
All-cause mortality
Time Frame
30 days, 1 year, 3 years
Title
All stroke (disabling and non-disabling)
Time Frame
30 days, 1 year, 3 years
Title
Life-threatening or disabling bleeding
Description
Fatal bleeding (Bleeding Academic Research Consortium (BARC) type 5)OR Bleeding in a critical organ, such as intracranial, intraspinal, intraocular, or pericardial necessitating pericardiocentesis, or intramuscular with compartment syndrome (BARC type 3b and 3c) OR Bleeding causing hypovolaemic shock or severe hypotension requiring vasopressors or surgery (BARC type 3b) OR Overt source of bleeding with drop in haemoglobin ≥5 g/dL or whole blood or packed red blood cells (RBCs) transfusion ≥4 units (BARC type 3b)
Time Frame
30 days, 1 year, 3 years
Title
Acute kidney injury (stage 2 or 3, including renal replacement therapy)
Description
Stage 2: Increase in serum creatinine to 200-299% (2.0-2.99 × increase compared with baseline) OR Urine output <0.5 mL/kg/h for >12 but <24 h Stage 3: Increase in serum creatinine to ≥300% (>3 × increase compared with baseline) OR serum creatinine of ≥4.0 mg/dL (≥354 mmol/L) with an acute increase of at least 0.5 mg/dL (44 mmol/L) OR Urine output <0.3 ml/kg/h for ≥24 h OR Anuria for ≥12 h Notes: The increase in creatinine must occur within 48 h. Patients receiving renal replacement therapy are considered to meet Stage 3 criteria irrespective of other criteria.
Time Frame
30 days, 1 year, 3 years
Title
Coronary artery obstruction requiring intervention
Time Frame
30 days, 1 year, 3 years
Title
Major vascular complication
Description
Aortic dissection, aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudo-aneurysm OR Access-related vascular injury (dissection, stenosis, perforation, rupture, arterio-venous fistula, pseudoaneurysm, haematoma, irreversible nerve injury, compartment syndrome, percutaneous closure device failure) leading to death, life-threatening or major bleeding, visceral ischaemia, or neurological impairment OR Distal embolization (non-cerebral) from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage OR Use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischaemia or neurological impairment OR Any new ipsilateral lower extremity ischaemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower extremity angiogram OR Surgery for access site-related nerve injury OR Permanent access site-related nerve injury
Time Frame
30 days, 1 year, 3 years
Title
Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention)
Time Frame
30 days, 1 year, 3 years
Title
Rehospitalization for valve-related symptoms or worsening congestive heart failure
Time Frame
30 days, 1 year, 3 years
Title
Valve-related dysfunction: prosthetic aortic valve stenosis AND/OR ≥ moderate prosthetic valve regurgitation
Description
Prosthetic aortic valve stenosis: mean gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1cm2 and/or DVI < 0.35)
Time Frame
30 days, 1 year, 3 years
Title
Conversion to open heart surgery
Time Frame
procedural
Title
Annular rupture
Time Frame
procedural
Title
New pacemaker implantation
Time Frame
30 days, 1 year, 3 years
Title
Valve thrombosis
Description
Any thrombus attached to or near an implanted valve that occludes part of the blood flow path, interferes with valve function, or is sufficiently large to warrant treatment. Note that valve-associated thrombus identified at autopsy in a patient whose cause of death was not valve-related should not be reported as valve thrombosis.
Time Frame
30 days, 1 year, 3 years
Title
Mean trans-prosthetic aortic gradient
Time Frame
30 days, 1 year, 3 years
Title
Aortic regurgitation
Time Frame
30 days, 1 year, 3 years
Title
Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score
Time Frame
30 days, 1 year, 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient with severe aortic stenosis defined by an aortic valve area (AVA) < 1cm2 or AVA indexed to body surface area (BSA) of < 0.6 cm2/m2, including low-flow severe aortic stenosis defined by stroke volume index (SVI) < 35ml/m2, as assessed by integration of echocardiographic and invasive measurements Subject is symptomatic (heart failure symptoms with New York Heart Association (NYHA) Functional Class > I, angina or syncope) Patient is considered at increased risk for mortality if undergoing conventional surgical aortic valve replacement or judged as not operable as determined either by a Logistic EuroSCORE > 20 % OR by a STS-PROM score > 10% OR by the heart team consisting of at least one cardiologist and cardiac surgeon based on the integration of individual clinical and anatomical factors not captured by risk-scores, the patient's age, frailty and life-expectancy The heart team agrees on eligibility of the patient for participation and that TAVI by transfemoral access constitutes the most appropriate treatment modality, from which the patient will likely benefit most Aortic annulus dimensions suitable for both valve types (area range: 338-573 mm2 AND perimeter range: 66-85 mm) based on ECG-gated multislice computed tomographic measurements. Findings of transesophageal echocardiography (TEE) and conventional aortography should be integrated in the anatomic assessment if available Arterial aorto-iliac-femoral axis suitable for transfemoral access with a minimum access vessel diameter ≥ 6 mm as assessed by multislice computed tomographic angiography and/or conventional angiography Written informed consent of the patient or her/his legal representative Patient understands the purpose, the potential risks as well as benefits of the trial and is willing to participate in all parts of the follow-up Exclusion Criteria: Non-valvular aortic stenosis Congenital aortic stenosis or unicuspid or bicuspid aortic valve Non-calcific acquired aortic stenosis Anatomy not appropriate for transfemoral transcatheter aortic valve implantation due to size of the aortic annulus or degree or eccentricity of calcification of the native aortic valve or tortuosity of the aorta or ilio-femoral arteries Emergency procedure including patients in cardiogenic shock (low cardiac output, vasopressor dependence, mechanical hemodynamic support) Severely reduced left ventricular (LV) function (ejection fraction < 20%) Pre-existing prosthetic heart valve in aortic position Presence of mitral valve prosthesis Concomitant planned procedure except for percutaneous coronary intervention (PCI) Planned non-cardiac surgery within 30 days Stroke within 30 days of the procedure. Myocardial infarction within 30 days of the procedure (except type 2) Evidence of intra-cardiac mass, thrombus or vegetation Severe coagulation conditions Inability to tolerate anticoagulation/anti-platelet therapy Active bacterial endocarditis or other active infections Hypertrophic cardiomyopathy with or without obstruction Contraindication to contrast media or allergy to nitinol Participation in another trial, which would lead to deviations in the preparation or performance of the intervention or the post-implantation management from this protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas Pigrim, Prof. MD
Organizational Affiliation
Bern University Hospital, Dep. of Cardiology, 3010 Bern, Switzerland
Official's Role
Principal Investigator
Facility Information:
Facility Name
Herz- und Gefäss-Klinik GmbH Bad Neustadt
City
Bad Neustadt An Der Saale
State/Province
Bad Neustadt
ZIP/Postal Code
97616
Country
Germany
Facility Name
Klinkum Augsburg
City
Augsburg
ZIP/Postal Code
86156
Country
Germany
Facility Name
Zentralklinik Bad Berka
City
Bad Berka
ZIP/Postal Code
99437
Country
Germany
Facility Name
Herz- und Gefässzentrum Bad Beversen
City
Bad Bevensen
ZIP/Postal Code
29549
Country
Germany
Facility Name
Kerckhoff-Klinik
City
Bad Nauheim
ZIP/Postal Code
61231
Country
Germany
Facility Name
St.-Johannes-Hospital
City
Dortmund
ZIP/Postal Code
44137
Country
Germany
Facility Name
Herzzentrum Dresden
City
Dresden
ZIP/Postal Code
01307
Country
Germany
Facility Name
Universitäres Herzzentrum Hamburg GmbH
City
Hamburg
ZIP/Postal Code
20251
Country
Germany
Facility Name
Städtisches Klinikum Karlsruhe
City
Karlsruhe
ZIP/Postal Code
76133
Country
Germany
Facility Name
ViDia Kliniken
City
Karlsruhe
ZIP/Postal Code
76135
Country
Germany
Facility Name
Klinik für Herzchirurgie Karlsruhe
City
Karlsruhe
ZIP/Postal Code
76185
Country
Germany
Facility Name
Herzzentrum Uniklinik Köln
City
Köln
ZIP/Postal Code
50931
Country
Germany
Facility Name
Herzzentrum Leipzig
City
Leipzig
ZIP/Postal Code
04289
Country
Germany
Facility Name
Deutsches Herzzentrum München
City
München
ZIP/Postal Code
80636
Country
Germany
Facility Name
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie
City
Regensburg
ZIP/Postal Code
93053
Country
Germany
Facility Name
University Medical Center Utrecht
City
Utrecht
ZIP/Postal Code
3584 CX
Country
Netherlands
Facility Name
Bern University Hospital
City
Bern
ZIP/Postal Code
3010
Country
Switzerland
Facility Name
Luzerner Kantonsspital
City
Luzern
ZIP/Postal Code
6000
Country
Switzerland
Facility Name
Universitätsspital Zürich
City
Zürich
ZIP/Postal Code
8091
Country
Switzerland
Facility Name
St Thomas' Hospital
City
London
ZIP/Postal Code
SE1 7EH
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31570258
Citation
Lanz J, Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Stortecky S, Heg D, Juni P, Windecker S, Pilgrim T; SCOPE I investigators. Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial. Lancet. 2019 Nov 2;394(10209):1619-1628. doi: 10.1016/S0140-6736(19)32220-2. Epub 2019 Sep 27.
Results Reference
result
PubMed Identifier
33750210
Citation
Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Blumenstein J, Stortecky S, Heg D, Kunzi A, Juni P, Windecker S, Pilgrim T, Lanz J; SCOPE I Investigators. One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a Balloon-Expandable Transcatheter Aortic Valve. Circulation. 2021 Mar 23;143(12):1267-1269. doi: 10.1161/CIRCULATIONAHA.120.052251. Epub 2021 Mar 22. No abstract available.
Results Reference
derived

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Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis.

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