Impact of Balloon Predilatation Between Self-expanding Valves in All Comers Undergoing TAVI
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Aortic Stenosis
- Sponsor
- National and Kapodistrian University of Athens
- Enrollment
- 78
- Locations
- 1
- Primary Endpoint
- Device success
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
A Multicenter, prospective, non-randomized, trial evaluating the safety and clinical efficacy of the next-generation, self-expandable Boston Scientific ACURATE NEO/TF Transcatheter Heart Valves, implanted in patients with severe aortic stenosis and the impact of predilatation in comparison with the Medtronic CoreValve EvolutT R/PRO systems from the DIRECT trial.
Detailed Description
The aim of the present prospective, multicenter, non-randomized trial is to compare the device success rate and the in-hospital and 30-day safety and echocardiographic clinical outcomes between TAVI with and without predilatation in all comers undergoing implantation of self-expanding valves. Primary endpoint will be device success rate as defined by the VARC-2 criteria. Secondary endpoints involve the composite endpoint of early safety at 30 days, according to the VARC-2 definitions, specifically all cause mortality, cardiovascular mortality, stroke, acute kidney injury, life-threatening or disabling bleeding, major vascular complication, as well as the echocardiographic outcomes and valve performance as designated by the VARC-2 definitions at 30 days. VARC-1 and VARC-3 device success rates will be estimated as well. Study type: Observational Estimated Enrollment: 75 patients Allocation: Non - randomized, all comers Primary Purpose: Treatment Observational Model: Case-Control Condition or disease: Aortic valve stenosis Intervention/Treatment: Device: Boston Scientific ACURATE neoTM transfemoral TAVI system Time Perspective: Prospective Participating centers: Hippokration Hospital (Athens, Greece), Silesian Center for Heart Diseases (Zabrze, Poland), Athens Naval Hospital (Athens, Greece). It is possible that the number of the participating center may change. Methods: Patients treated with the Boston Scientific ACURATE NEO/TF system will be prospectively. All patients will be followed for at least 30 days.
Investigators
Konstantinos Toutouzas
Professor
National and Kapodistrian University of Athens
Eligibility Criteria
Inclusion Criteria
- •Patient with severe symptomatic aortic stenosis defined by a mean aortic gradient \> 40 mmHg or peak jet velocity \> 4.0 m/s or an aortic valve area (AVA) \< 1cm2 or AVA indexed to body surface area (BSA) of \<0.6 cm2/m2
- •Patient is symptomatic (heart failure with New York Heart Association (NYHA) Functional Class \> I, angina or syncope)
- •Patients are considered at high risk for mortality with conventional surgical aortic valve replacement as assessed by a Heart Team consisting of a cardiologist and surgeon or as confirmed by a logistic EuroSCORE I ≥ 20% and / or EuroSCORE II ≥ 7% STS score ≥ 8% OR
- •Over 80 years old OR
- •Over 65 years old with 1 or 2 (but not more than two) from the following criteria:
- •Liver cirrhosis (Class A or B). Pulmonary insufficiency: VMS\<1 liter. Previous heart surgery (CABG, vascular surgery). Porcelain aorta. Pulmonary artery systolic pressure \>60 mmHg and high risk for heart surgery. Relapsing pulmonary embolism. Right ventricular insufficiency. Thoracic wall injuries that contraindicate an open heart surgery. History of radiation therapy of the mediastinum. Connective tissue disease that contraindicates an open heart surgery. Frailty/cachexia.
- •Aortic valve diameter of ≥20mm and ≤2 9mm as measured by echo.
- •Ascending aorta diameter ≤ 43 mm at the sinotubular junction.
- •Arterial aorto-iliac-femoral axis suitable for transfemoral access as assessed by conventional angiography and/or multi-detector computed tomographic angiography (access vessel diameter ≥ 6mm)
- •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
- •A known hypersensitivity or contraindication to any of the following which cannot be adequately pre-medicated: aspirin or heparin and bivalirudin, ticlodipine and clopidogrel, nitinol (titanium or nickel), contrast media
- •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 Heart Team assessment.
- •Echocardiographic evidence of LV or LA thrombus.
- •Mitral or tricuspid valve insufficiency (\> grade II).
- •Previous aortic valve replacement (mechanical or bioprosthetic).
- •Recent (within 6 months of Heart Team assessment) cerebrovascular accident (CVA) or transient ischemic attack (TIA).
- •Patients with:
- •Femoral, iliac or aortic vascular disease (stenosis etc) that precludes the insertion of a transcatheter sheath.
- •OR Symptomatic carotid or vertebral artery disease (\> 70% stenosis).
Outcomes
Primary Outcomes
Device success
Time Frame: 30 days
ACURATE NEO/TF device implantation success rates, as designated by the VARC-2 criteria
Secondary Outcomes
- All cause Mortality(30 days)
- Post-dilatation(30 days)
- Major Vascular complications(30 days)
- All stroke(30 days)
- New pacemaker implantation(30 days)
- Echocardiographic endpoint(30 days)
- Acute kidney injury stage 2 or 3(30 days)
- Device success(30 days)
- Major Bleeding(30 days)