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First in Human Feasibility Study With ADAPT 3D - ALR for Aortic Leaflet Repair

Primary Purpose

Aortic Stenosis, Aortic Insufficiency

Status
Recruiting
Phase
Not Applicable
Locations
Belgium
Study Type
Interventional
Intervention
Implantation of ADAPT 3D ALR
Sponsored by
Anteris Technologies Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Aortic Stenosis focused on measuring ADAPT, aortic leaflet repair, aortic valve

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patient is older than 18 years of age and ≤ 85 years.
  2. The subject's aortic annular measurements are ≥ 21 mm to < 27mm as confirmed on pre-op echo.
  3. The subject is a candidate for Aortic Valve Replacement.
  4. The subject has documented moderate or severe Aortic Stenosis and/or Aortic Insufficiency (defined as grade 2, 3 or 4).
  5. The subject is willing and able to comply with specified follow-up requirements and evaluations, including transesophageal echocardiography (TEE) if there are inadequate images by transthoracic echocardiography (TTE) to assess the aortic valve.
  6. Patient has signed the informed consent

Exclusion Criteria:

  1. All patients who require emergency surgery (within 24 hours of a presentation to an emergency department) for any reason.
  2. Subject with a pre-existing valve prosthesis in the aortic position.
  3. Patients requiring repair of other cardiac valves will be excluded.
  4. Subject with active endocarditis.
  5. Heavily calcified aortic roots or "porcelain aortas".
  6. Leukopenia with a WBC (white Blood Cells) of less than 3000.
  7. Acute anaemia with a haemoglobin less than 8 g/dL.
  8. Platelet count less than 100,000 platelets/microliter, and if less than 150,000 platelets/microliter, platelet reduction of >10,000 platelets/microliter per day over two consecutive days (Note: Where a platelet count is less than 150,000 platelets/microliter but greater than 100,000 platelets/microliter, platelet count testing is to be conducted over 2 consecutive days. If platelets are reducing over those two consecutive days, the rate of reduction in platelets must be less than 10,000 platelets/microliter per day, otherwise the participant must be excluded).
  9. History of a defined bleeding diathesis or coagulopathy or the subject refuses blood transfusions.
  10. Active infection requiring antibiotic therapy (if temporary illness, subjects may enroll 2-4 weeks after discontinuation of antibiotics).
  11. Subjects in whom transesophageal echocardiography (TEE) is contraindicated.
  12. Low EF < 50 %.
  13. Life expectancy < 1 year, or severe comorbidities, such as cancer, dialysis, or severe COPD.
  14. The subject is an illicit drug user, alcohol abuser, prisoner, institutionalised, or is unable to give informed consent.
  15. The subject is pregnant or lactating (non-pregnancy to be confirmed by pregnancy test for all child bearing potential females).
  16. Recent (within 6 months) cerebrovascular accident (CVA) or a transient ischemic attack (TIA).
  17. Myocardial Infarction (MI) within one month of trial inclusion.
  18. Currently participating in, or have been recently exited from (within 30 days of enrollment in this study), or plan to be enrolled in another clinical

Sites / Locations

  • University Hospital LeuvenRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ADAPT 3D ALR

Arm Description

Patients treated with ADAPT 3D ALR

Outcomes

Primary Outcome Measures

mean pressure gradient (mmHg) across the valve (less than 20 mmHg)
Hemodynamic Performance Assessment
derived Effective Orifice Area (EOA) range > 0.9 cm2 (19mm valve) to > 1.6 cm2 (27mm valve)
Hemodynamic Performance Assessment
rate of thromboembolism
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
rate of valve thrombosis
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
rate of major paravalvular leak
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
rate of major hemorrhage
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
rate of endocarditis
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.

Secondary Outcome Measures

Rate of Atrial Fibrillation 6 months post procedure
New/post-operative atrial fibrillation - confirmed on ECG after closure till 6 months
number of days in ICU
Length of stay in the ICU post valve implantation defined as arrival time/date in hours and minutes to transfer to ward time/date in hours and minutes.
NYHA (New York Heart Association) class Improvement Assessment
Clinically significant improvement (one grade) in the New York Heart Association (NYHA) functional classification. 4 classes of disease: min value Class IV (cardiac disease resulting in inability to carry on any physical activity without discomfort); max value Class I (cardiac disease but without resulting limitations of physical activity)
number of days in hospital post procedure
Post procedure length of stay defined as the date and time in hours and minutes documented for arrival in the recovery unit to date and time in hours and minutes of discharge in hours and minutes.
hemoglobin assessment
Hemolysis screen measured by blood test
Alanine transaminase (ALT)
Hemolysis screen measured by blood test of liver enzyme
Aspartate transaminase (AST)
Hemolysis screen measured by blood test of liver enzyme
Rate of all-caused death
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of valve related death
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of valve-related reoperation
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of valve explant
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of hemorrhage
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of all-cause reoperation
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Rate of Device deficiency
Device deficiency measured by echo

Full Information

First Posted
November 19, 2019
Last Updated
February 15, 2022
Sponsor
Anteris Technologies Ltd.
Collaborators
Factory CRO for Medical Devices B.V.
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1. Study Identification

Unique Protocol Identification Number
NCT04178213
Brief Title
First in Human Feasibility Study With ADAPT 3D - ALR for Aortic Leaflet Repair
Official Title
First in Human Surgical Implantation of Single Piece ADAPT® Treated 3D ALR (Aortic Leaflet Repair), Feasibility and Clinical Safety Study
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Recruiting
Study Start Date
March 26, 2020 (Actual)
Primary Completion Date
June 2022 (Anticipated)
Study Completion Date
June 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Anteris Technologies Ltd.
Collaborators
Factory CRO for Medical Devices B.V.

4. Oversight

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

5. Study Description

Brief Summary
This study will evaluate the safety and performance of the ADAPT 3D - ALR in adult patients requiring replacement of aortic valve. 15 patients in one site in Belgium will all be treated with ADAPT 3D - ALR.
Detailed Description
The purpose of this study is to conduct the initial clinical investigation of single piece ADAPT treated 3D - ALR (Aortic Leaflet Repair) to collect evidence on the device's safety and performance. The study is anticipated to confirm successful clinical safety and clinical performance with significant improvements in clinical hemodynamic performance. The ADAPT® technology is used to process animal derived tissues to produce implantable tissue prosthetic devices that are compatible with the human body. This technology has been shown to produce reliable, biocompatible and versatile regenerative prosthetic devices capable of being used instead of synthetic products currently used in many soft tissue repair applications. 15 patients with aortic valve insufficiency or stenosis will be enrolled in this single arm single site study. Follow-up will continue through to 26 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Aortic Stenosis, Aortic Insufficiency
Keywords
ADAPT, aortic leaflet repair, aortic valve

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
prospective, non-randomised, single arm, single-centre First In Human clinical investigation
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ADAPT 3D ALR
Arm Type
Experimental
Arm Description
Patients treated with ADAPT 3D ALR
Intervention Type
Device
Intervention Name(s)
Implantation of ADAPT 3D ALR
Intervention Description
The operation is performed through a median sternotomy and with the hemodynamic support of standard cardiopulmonary bypass (CBP). diseased leaflets are excised meticulously. Calcifications at the level of the annulus will be removed just like in any other aortic valve replacement procedure. The annulus will be sized and the appropriate 3D single piece valve will be chosen. The implant technique will consist out of one running suture line at the level of the annulus, followed by fixation of the 3 commissural parts against the aortic wall. Valve competence and function will be assessed visually, and by TEE immediately coming of bypass.
Primary Outcome Measure Information:
Title
mean pressure gradient (mmHg) across the valve (less than 20 mmHg)
Description
Hemodynamic Performance Assessment
Time Frame
6 months following implantation
Title
derived Effective Orifice Area (EOA) range > 0.9 cm2 (19mm valve) to > 1.6 cm2 (27mm valve)
Description
Hemodynamic Performance Assessment
Time Frame
6 months following implantation
Title
rate of thromboembolism
Description
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
Time Frame
6 months following implantation
Title
rate of valve thrombosis
Description
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
Time Frame
6 months following implantation
Title
rate of major paravalvular leak
Description
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
Time Frame
6 months following implantation
Title
rate of major hemorrhage
Description
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
Time Frame
6 months following implantation
Title
rate of endocarditis
Description
The adverse events consistent with the Objective Performance Criteria (OPC), for flexible heart valves will be compared to those rates defined as acceptable levels in the standard.
Time Frame
6 months following implantation
Secondary Outcome Measure Information:
Title
Rate of Atrial Fibrillation 6 months post procedure
Description
New/post-operative atrial fibrillation - confirmed on ECG after closure till 6 months
Time Frame
6 months post procedure
Title
number of days in ICU
Description
Length of stay in the ICU post valve implantation defined as arrival time/date in hours and minutes to transfer to ward time/date in hours and minutes.
Time Frame
30 days post procedure
Title
NYHA (New York Heart Association) class Improvement Assessment
Description
Clinically significant improvement (one grade) in the New York Heart Association (NYHA) functional classification. 4 classes of disease: min value Class IV (cardiac disease resulting in inability to carry on any physical activity without discomfort); max value Class I (cardiac disease but without resulting limitations of physical activity)
Time Frame
6 months post procedure
Title
number of days in hospital post procedure
Description
Post procedure length of stay defined as the date and time in hours and minutes documented for arrival in the recovery unit to date and time in hours and minutes of discharge in hours and minutes.
Time Frame
30 days post procedure
Title
hemoglobin assessment
Description
Hemolysis screen measured by blood test
Time Frame
6 months post procedure
Title
Alanine transaminase (ALT)
Description
Hemolysis screen measured by blood test of liver enzyme
Time Frame
6 months post procedure
Title
Aspartate transaminase (AST)
Description
Hemolysis screen measured by blood test of liver enzyme
Time Frame
6 months post procedure
Title
Rate of all-caused death
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of valve related death
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of valve-related reoperation
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of valve explant
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of hemorrhage
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of all-cause reoperation
Description
The rate will be compared to clinical outcomes for surgically implanted heart valves reported in the literature.
Time Frame
6 months following implantation
Title
Rate of Device deficiency
Description
Device deficiency measured by echo
Time Frame
6 months following implantation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is older than 18 years of age and ≤ 85 years. The subject's aortic annular measurements are ≥ 21 mm to < 27mm as confirmed on pre-op echo. The subject is a candidate for Aortic Valve Replacement. The subject has documented moderate or severe Aortic Stenosis and/or Aortic Insufficiency (defined as grade 2, 3 or 4). The subject is willing and able to comply with specified follow-up requirements and evaluations, including transesophageal echocardiography (TEE) if there are inadequate images by transthoracic echocardiography (TTE) to assess the aortic valve. Patient has signed the informed consent Exclusion Criteria: All patients who require emergency surgery (within 24 hours of a presentation to an emergency department) for any reason. Subject with a pre-existing valve prosthesis in the aortic position. Patients requiring repair of other cardiac valves will be excluded. Subject with active endocarditis. Heavily calcified aortic roots or "porcelain aortas". Leukopenia with a WBC (white Blood Cells) of less than 3000. Acute anaemia with a haemoglobin less than 8 g/dL. Platelet count less than 100,000 platelets/microliter, and if less than 150,000 platelets/microliter, platelet reduction of >10,000 platelets/microliter per day over two consecutive days (Note: Where a platelet count is less than 150,000 platelets/microliter but greater than 100,000 platelets/microliter, platelet count testing is to be conducted over 2 consecutive days. If platelets are reducing over those two consecutive days, the rate of reduction in platelets must be less than 10,000 platelets/microliter per day, otherwise the participant must be excluded). History of a defined bleeding diathesis or coagulopathy or the subject refuses blood transfusions. Active infection requiring antibiotic therapy (if temporary illness, subjects may enroll 2-4 weeks after discontinuation of antibiotics). Subjects in whom transesophageal echocardiography (TEE) is contraindicated. Low EF < 50 %. Life expectancy < 1 year, or severe comorbidities, such as cancer, dialysis, or severe COPD. The subject is an illicit drug user, alcohol abuser, prisoner, institutionalised, or is unable to give informed consent. The subject is pregnant or lactating (non-pregnancy to be confirmed by pregnancy test for all child bearing potential females). Recent (within 6 months) cerebrovascular accident (CVA) or a transient ischemic attack (TIA). Myocardial Infarction (MI) within one month of trial inclusion. Currently participating in, or have been recently exited from (within 30 days of enrollment in this study), or plan to be enrolled in another clinical
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Factory CRO
Phone
+31 30 229 2727
Email
jurriaan.sombeek@avaniaclinical.com
First Name & Middle Initial & Last Name or Official Title & Degree
Deanna Linden
Phone
+1 651 493 0606
Ext
1012
Email
dlinden@anteristech.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bart Meuris, Prof. Dr.
Organizational Affiliation
Universitaire Ziekenhuizen KU Leuven
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Klaartjie Van den Bossche
Phone
+32 16 34 21 60
Email
klaartje.vandenbossche@uzleuven.be
First Name & Middle Initial & Last Name & Degree
Peter Verbrugghe

12. IPD Sharing Statement

Learn more about this trial

First in Human Feasibility Study With ADAPT 3D - ALR for Aortic Leaflet Repair

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