Medtronic CoreValve Evolut R U.S. Clinical Study
Aortic Stenosis
About this trial
This is an interventional treatment trial for Aortic Stenosis
Eligibility Criteria
Inclusion Criteria - Severe aortic stenosis, defined as aortic valve area of < 1.0 cm2 (or aortic valve area index of < 0.6 cm2/m2) by the continuity equation, AND mean gradient > 40 mmHg or maximal aortic valve velocity > 4.0 m/sec by resting echocardiogram.
Subjects with low-flow/low gradient severe aortic stenosis can be included, provided low-dose dobutamine or exercise stress echocardiography demonstrates a mean gradient of >40 mmHg or a maximal aortic valve velocity of >4.0 m/sec, AND aortic valve area of <1.0cm2 (or aortic valve area index of <0.6 cm2/m2).
- STS score of ≥ 8 OR documented heart team agreement of ≥ high risk for AVR due to frailty or co-morbidities.
- Symptoms of aortic stenosis, AND NYHA Functional Class II or greater
- The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.
Exclusion Criteria
- Any condition considered a contraindication for placement of a bioprosthetic valve (e.g. subject is indicated for mechanical prosthetic valve).
- A known hypersensitivity or contraindication to any of the following which cannot be adequately pre-medicated: aspirin or heparin (HIT/HITTS) and bivalirudin, ticlopidine and clopidogrel, Nitinol (titanium or nickel), contrast media
- Blood dyscrasias as defined: leukopenia (WBC < 1000 mm3), thrombocytopenia (platelet count <50,000 cells/mm3), history of bleeding diathesis or coagulopathy, or hypercoagulable states.
- Untreated clinically significant coronary artery disease requiring revascularization.
- Severe left ventricular dysfunction with left ventricular ejection fraction (LVEF) < 20% by echocardiography, contrast ventriculography, or radionuclide ventriculography.
- End stage renal disease requiring chronic dialysis or creatinine clearance < 20 cc/min.
- Ongoing sepsis, including active endocarditis.
- Any percutaneous coronary or peripheral interventional procedure with a bare metal or drug eluting stent performed within 30 days prior to the study procedure.
- Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 10 weeks of Heart Team assessment.
- Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or mechanical hemodynamic support.
- Recent (within 6 months of Heart Team assessment) cerebrovascular accident (CVA) or transient ischemic attack (TIA).
- Gastrointestinal (GI) bleeding that would preclude anticoagulation.
- Subject refuses a blood transfusion.
- Severe dementia (resulting in either inability to provide informed consent for the study/procedure, prevents independent lifestyle outside of a chronic care facility, or will fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits).
- Estimated life expectancy of less than 12 months due to associated non-cardiac co-morbid conditions.
- Other medical, social, or psychological conditions that in the opinion of the investigator precludes the subject from appropriate consent or adherence to the protocol required follow-ups exams.
- Currently participating in an investigational drug or another device study (excluding registries).
- Evidence of an acute myocardial infarction ≤ 30 days before the study procedure.
- Need for emergency surgery for any reason.
- Liver failure (Child-Pugh class C).
- Subject is pregnant or breast feeding.
Anatomical exclusion criteria:
- Pre-existing prosthetic heart valve in any position.
- Mixed aortic valve disease (aortic stenosis with severe aortic regurgitation).
- Severe mitral regurgitation.
- Severe tricuspid regurgitation.
- Moderate or severe mitral stenosis.
- Hypertrophic obstructive cardiomyopathy.
- Echocardiographic or Multi-Slice Computed Tomography (MSCT) evidence of intracardiac mass, thrombus, or vegetation.
- Congenital bicuspid or unicuspid valve verified by echocardiography.
For transfemoral or transaxillary (subclavian) acess:
- Access vessel diameter <5.0mm or <6.0mm for patent LIMA
Sites / Locations
- Banner Good Samaritan Medical Center
- University of Southern California
- Yale New Haven Hospital
- Washington Hospital Center/Medstar
- St. Vincent Heart Center of Indiana/The Care Group, LLC
- University of Kansas
- The Johns Hopkins University
- Beth Israel Deaconcess Medical Center
- University of Michigan Health Systems
- Detroit Medical Center Cardiovascular Institute
- Spectrum Health
- Morristown Memorial Hospital
- New York Langone Medical Center
- The Mount Sinai Medical Center
- Columbia University Medical Center
- St. Francis Hospital
- Duke University Medical Center
- Riverside Methodist Hospital/Ohio Health Research Institute
- University of Pittsburg Medical Center
- Pinnacle Health
- Baylor Heart and Vascular Hospital
- The Methodist DeBakey Heart & Vasc Ctr/The Methodist Hosp
- Aurora Health Care/St Luke's Medical Center
Arms of the Study
Arm 1
Experimental
CoreValve Evolut R TAVR system
The CoreValve Evolut R System is a transcatheter aortic valve implantation system comprised of the following three components: Evolut R Transcatheter Aortic Valve (TAV) EnVeo R Delivery Catheter System (DCS) with EnVeo R InLine Sheath EnVeo R Loading System (LS)