Randomized Trial of TAVI vs. SAVR in Patients With Severe Aortic Valve Stenosis at Intermediate Risk of Mortality (DEDICATE)
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 Replacement, Surgical aortic valve replacement, Low to intermediate operative risk
Eligibility Criteria
Inclusion Criteria:
Heart team consensus that TAVI and SAVR are both medically justified and advisable based on:
Degenerative aortic valve stenosis with echocardiographically derived criteria:
- Mean gradient >40 mmHg or
- Jet velocity greater than 4.0 m/s or
- Aortic valve area (AVA) of < 1.0 cm2 (indexed effective orifice area < 0.6cm2/m2).
Patient is symptomatic from his/her aortic valve stenosis
- New York Heart Association Functional Class ≥ II or
- Angina pectoris or
- Syncope.
- Patient is classified as low to intermediate operative risk as assessed by the local heart team according to the variables outlined in the 2017 ESC/EACTS Guidelines for the Management of valvular heart disease, taking into account cardiac and extracardiac Patient characteristics and established risk scores (e.g. STS-PROM, EuroSCORE).
- A transfemoral or alternative (e.g. transapical, transaortic, transaxillary) access for TAVI seems feasible. Centers should follow a "transfemoral first" strategy for the primary route of access; however, other routes of access are also allowed, as decided by local heart team consensus.
- Patient has provided written informed consent to participate in the trial.
- Ability of the patient to understand the patient information and to personally sign and date the informed consent to participate in the study, before performing any study related procedures.
- The patient agrees to undergo SAVR, if randomized to control treatment.
- The patient and the treating physician agree that the patient will return for all required post-procedure follow-up visits.
- Patients aged 65 to 85 years.
- Male patients or females who are postmenopausal defined as no menses for 12 months without an alternative medical cause.
Exclusion Criteria:
- Aortic valve is a congenital unicuspid or congenital bicuspid valve, or is non-calcified
- Untreated clinically significant coronary artery disease considered a contraindication to an isolated aortic valve procedure (TAVI or SAVR) according to heart team consensus
- Previous cardiac surgery
- Any percutaneous coronary intervention performed within 1 month prior to the study procedure
- Untreated severe mitral or tricuspid regurgitation
- Untreated severe mitral stenosis
- Hemodynamic instability requiring inotropic support or mechanical circulatory support
- Ischemic stroke or intracranial bleeding within 1 month
- Severe ventricular dysfunction with left ventricular ejection fraction < 20% as measured by resting echocardiogram
- Hypertrophic obstructive cardiomyopathy or severe basal septal hypertrophy with outflow gradient
- Echocardiographic evidence of an intracardiac mass, thrombus, vegetation or endocarditis
- Any other condition considered a contraindication for an isolated aortic valve procedure
- Symptomatic carotid or vertebral artery disease
- Expected life expectancy < 12 months due to associated non-cardiac comorbidities
- Currently participating in another investigational drug or device trial
Sites / Locations
- Uniklinik Rheinisch-Westfälische Technische Hochschule Aachen
- Universitäts-Herzzentrum Freiburg-Bad Krozingen
- Kerckhoff-Klinik Bad Nauheim
- Herz- und Gefässklinik Bad Neustadt/Saale
- Herz- und Diabeteszentrum NRW Bad Oeynhausen
- Charité Universitätsmedizin Berlin (Campus Benjamin-Franklin)
- Charité Universitätsmedizin Berlin (Campus Mitte)
- Charité Universitätsmedizin Berlin (Campus Virchow)
- Deutsches Herzzentrum Berlin
- Vivantes Friedrichshain
- Vivantes Humboldt Kliniken
- Vivantes Klinikum am Urban
- Vivantes Neukölln
- Immanuel Klinikum Bernau
- Kliniken der Ruhr-Universität Bochum
- Medizinische Hochschule Brandenburg Theodor Fontane
- Herzzentrum Dresden an der Technischen Universität Dresden
- Universitätsklinikum Düsseldorf
- Universitätsklinikum Erlangen
- Universitätsklinikum Essen, Klinikum für Kardiologie und Angiologie am Westdeutschen Herz- und Gefäßzentrum
- Universitätsklinikum Frankfurt
- Universitäts-Herzzentrum Freiburg-Bad Krozingen
- Universitätsklinikum Giessen und Marburg
- Universitätsmedizin Greifswald / Klinikum Karlsburg
- Universitätsklinikum Göttingen
- Universitätsklinikum Halle (Saale)
- Universitäres Herz- und Gefäßzentrum Hamburg (UHZ)
- Medizinische Hochschule Hannover
- Universitätsklinikum Heidelberg
- Universitätsklinikum Jena
- Universitätsklinikum Schleswig-Holstein
- Bundeswehrzentralkrankenhaus Koblenz
- Herzzentrum der Uniklinik Köln
- Deutsches Herzzentrum Leipzig
- Universitäres Herzzentrum Lübeck
- Otto-von Guericke-Universität Magdeburg
- Universitätsmedizin Mainz
- Deutsches Herzzentrum München
- LMU Klinikum der Universität München
- Universitätsklinikum Münster
- Universitätsklinikum Regensburg
- Robert Bosch Krankenhaus
- Universitätsklinikum Ulm
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Transcatheter aortic valve implantation
Surgical aortic valve replacement
Transcatheter aortic valve implantation (TAVI) using the most appropriate CE (Conformité Européene)-marked device available, with a minimum demand of experience of 30 implanted devices/type per center.
Surgical aortic valve replacement (SAVR) with free choice of surgical bioprosthesis and free choice of surgical access according to the surgeon's preference.