Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis. (SCOPE I)
Aortic Valve Stenosis
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
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
Active Comparator
Active Comparator
Symetis ACURATE neo/TF transfemoral TAVI system
Edwards Sapien 3 Transcatheter Heart Valve
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)