Nordic Aortic Valve Intervention Trial 2 - A Randomized Multicenter Comparison of Transcatheter Versus Surgical Aortic Valve Replacement in Younger Low Surgical Risk Patients With Severe Aortic Stenosis
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 376
- 试验地点
- 9
- 主要终点
- Composite rate of all-cause mortality, stroke and rehospitalization (related to the procedure, the valve or heart failure) within one year after the procedure.
研究概览
简要总结
A randomized clinical trial investigating transcatheter (TAVR) versus surgical (SAVR) aortic valve replacement in patients 75 years of age or younger suffering from severe aortic valve stenosis.
Study hypothesis: The clinical outcome (death of any cause, stroke and rehospitalization (related to the procedure, valve or heart failure)) obtained within one year after TAVR is non-inferior to SAVR.
详细描述
BACKGROUND: Acquired aortic valve stenosis (AS) is the most common heart valve disease in the Western World with a prevalence of 2-7% at the age of >65 years. If untreated, it may lead to heart failure and death. Surgical aortic valve replacement (SAVR) until recent years has been the definitive treatment for patients with severe symptomatic AS. A less invasive transcatheter aortic valve replacement (TAVR) has been developed and has been a treatment of choice mostly for elderly high risk or inoperable patients. As TAVR technology is continuously evolving and improving, it may be anticipated that it will become a valuable alternative - and even the preferred choice of treatment - for younger, low-risk patients with severe aortic valve stenosis in the near future. However, to date, there is no clinical evidence that supports this hypothesis.
AIM: The purpose of the study is to compare TAVR and SAVR with regard to the intra- and post-procedural morbidity and mortality rate, hospitalization length, functional capacity, quality of life, and valvular prosthesis function in younger, low risk patients with severe bicuspid or tricuspid AS, scheduled for aortic valve replacement.
POPULATION: Younger low risk patients with severe aortic valve stenosis, which are scheduled for aortic valve replacement using a bioprosthesis. Subjects fulfilling the inclusion criteria, not having any exclusion criteria, and consenting to the trial will be randomized 1:1 to TAVR or SAVR with 186 patients in each group.
DESIGN: The study is a randomized clinical multicenter trial. Central randomization with variable block size and stratification by gender and coronary comorbidity will be used. An independent event committee blinded to treatment allocation will adjudicate safety endpoints.
INTERVENTIONS:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 75 years or younger.
- •Severe calcific AS (Valve area <1cm2 (or <0.6 cm2/m2) AND one of the two following criteria: mean gradient >40mmHg or peak jet velocity >4.0m/s, OR in presence of low flow, low gradient with reduced or normal LVEF<50%, a dobutamine stress echo should verify true severe AS rather than pseudo-AS
- •Symptomatic with angina pectoris, dyspnea or exercise-induced syncope or near syncope OR asymptomatic with abnormal exercise test showing symptoms on exercise clearly related to AS or systolic LV dysfunction (LVEF <50%) not due to another cause.
- •Anticipated usage of biological aortic valve prosthesis.
- •Low risk for conventional surgery (STS Score <4%).
- •Suitable for both SAVR and transfemoral TAVR.
- •Life expectancy >1 year after the intervention.
- •Informed consent to participate in the study after adequate information about the study before randomization and intervention.
排除标准
- •Coronary artery disease, not suitable for both percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG).
- •Coronary angiogram with a SYNTAX-score >
- •LVEF <25% without contractile reserve during dobutamine stress echocardiography.
- •Porcelain aorta, which prevents open-heart surgery.
- •Bicuspid valve with aorta ascendens diameter ≥45mm
- •Severe femoral, iliac or aortic atherosclerosis, calcification, coarctation, aneurysm or tortuosity, which prevents transfemoral TAVR.
- •Need for open heart surgery other than SAVR with or without CABG.
- •Myocardial infarction within last 30 days
- •Stroke or TIA within the last 30 days. NOTION-2,
- •February 2017, version 5 9
- •Current endocarditis, intracardiac tumor, thrombus or vegetation.
- •Ongoing severe infection requiring intravenous antibiotics.
- •Unstable pre-procedural condition requiring intravenous inotropes or mechanical assist device (IABP, Impella) on the day of intervention.
- •Kidney disease requiring dialysis or severely impaired lung function (FEV1 and/or diffusion capacity <40% of predicted).
- •Allergy to heparin, iodid contrast agent, warfarin, aspirin or clopidogrel.
研究组 & 干预措施
Transcatheter aortic valve replacement
Transcatheter aortic valve replacement
干预措施: Transcatheter aortic valve replacement (Device)
Surgical aortic valve replacement
Surgical aortic valve replacement
干预措施: Surgical aortic valve replacement (Device)
结局指标
主要结局
Composite rate of all-cause mortality, stroke and rehospitalization (related to the procedure, the valve or heart failure) within one year after the procedure.
时间窗: at one year post-procedural.
VARC-3 definitions
次要结局
- Composite rate of all-cause mortality and disabling stroke(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- All-cause mortality(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Myocardial Infarction(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Composite rate of all-cause mortality, stroke and rehospitalization (related to the procedure, the valve or heart failure)(at 1 month and yearly thereafter up to 10 years post-procedure)
- Cardiovascular mortality(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Stroke(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Non-disabling stroke(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Need for aortic valve re-intervention(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Vascular complication (major)(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- NYHA functional class(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Need for permanent pacemaker(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- New onset atrial fibrillation captured on ECG(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Procedure time(Intraoperative)
- Duration of index hospitalization(Number of days from admission to discharge (expected an averge of 7 days))
- Composite rate of all-cause mortality, disabling stroke and rehospitalization (related to the procedure, the valve or heart failure)(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Rehospitalization both composite and individual of related to the procedure, the valve or heart failure)(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Disabling Stroke(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Transient Ischemic attack(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Endocarditis(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Acute kidney injury (stage 2 or 3)(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Non-cardiovascular mortality(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Valve Thrombosis(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Bleeding (life-threatening or major)(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Echocardiographic aortic bioprosthesis performance (degree of paravalvular leakage, valve area, mean gradient, prosthesis patient mismatch)(at discharge, 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Left ventricle remodeling as assesed by echocardiography(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
- Quality of life change from baseline(at 1 and 12 months, and yearly thereafter up to 10 years post-procedure)
研究者
Ole De Backer
MD, PhD
Rigshospitalet, Denmark