PARTNER 3 Trial - Aortic Valve-in-Valve

Official title

A Prospective, Single-Arm, Multicenter Study to Investigate the Safety and Effectiveness of SAPIEN 3/SAPIEN 3 Ultra Transcatheter Heart Valve Implantation in Patients With a Failing Aortic Bioprosthetic Valve

Overview

This study will assess the safety and effectiveness of the SAPIEN 3/SAPIEN 3 Ultra transcatheter heart valve (THV) in patients with a failing aortic bioprosthetic valve.

Detailed description

This is a prospective, single-arm, multicenter study.

Interventions

• Device Edwards SAPIEN 3/SAPIEN 3 Ultra THV
  Edwards SAPIEN 3/SAPIEN 3 Ultra THV system with the associated delivery systems.

Primary outcome measures

• Safety and Effectiveness - Non-hierarchical composite of all-cause mortality and stroke [Time frame: 1 year]

Secondary outcome measures (5)

• Mean gradient [Time frame: 30 days]
• Peak gradient [Time frame: 30 days]
• Kansas City Cardiomyopathy Questionnaire (KCCQ) [Time frame: 30 days]
• New York Heart Association (NYHA) Classification [Time frame: 30 days]
• Six-Minute Walk Test (6MWT) [Time frame: 30 days]

Eligibility criteria

Inclusion criteria

• Failing surgical or transcatheter bioprosthetic valve in the aortic position demonstrating ≥ moderate stenosis and/or ≥ moderate insufficiency.
• Bioprosthetic valve with a true internal diameter (True ID) of 18.5 mm to 28.5 mm.
• NYHA Functional Class ≥ II.
• Heart Team agrees the patient is low to intermediate risk.
• Heart Team agrees valve implantation will likely benefit the patient.
• The study patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent.

Exclusion criteria

• Surgical or transcatheter valve in the mitral position (mitral rings are not an exclusion)
• Severe regurgitation (> 3+) or stenosis of any other valve
• Failing valve has moderate or severe paravalvular regurgitation
• Failing valve is unstable, rocking, or not structurally intact
• Increased risk of coronary obstruction by prosthetic leaflets of the failing valve.
• Increased risk of embolization of THV
• Known bioprosthetic valve with residual mean gradient > 20 mmHg at the end of the index procedure for implantation of the original valve
• Iliofemoral vessel characteristics that would preclude safe placement of the introducer sheath (Transfemoral)
• Anatomical characteristics that would preclude safe access to the ascending aorta (Transaortic)
• Anatomical characteristics that would preclude safe access to the apex (Transapical)
• Evidence of an acute myocardial infarction ≤ 30 days before enrollment
• Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 30 days prior to the index procedure. Implantation of a permanent pacemaker or implantable cardioverter defibrillator is not considered an exclusion.
• Patients with planned concomitant surgical or transcatheter ablation for Atrial Fibrillation
• Leukopenia, anemia, thrombocytopenia, history of bleeding diathesis or coagulopathy or hypercoagulable states
• Untreated clinically significant coronary artery disease requiring revascularization
• Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation, or mechanical heart assistance within 30 days of enrollment
• Emergency interventional/surgical procedures within 30 days prior to the procedure
• Any planned surgical, percutaneous coronary, or peripheral procedure to be performed within the 30-day follow-up from the procedure
• Hypertrophic cardiomyopathy with obstruction
• LVEF < 30%
• Cardiac imaging evidence of intracardiac mass, thrombus, or vegetation
• Inability to tolerate or condition precluding treatment with antithrombotic/anticoagulation therapy during or after the valve implant procedure
• Absolute contraindications or allergy to iodinated contrast that cannot be adequately treated with premedication
• Stroke or transient ischemic attack within 90 days of enrollment
• Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 30 days of enrollment
• Renal insufficiency and/or renal replacement therapy at the time of screening
• Active bacterial endocarditis within 180 days of the procedure
• Patient refuses blood products
• Estimated life expectancy < 24 months
• Positive urine or serum pregnancy test in female subjects of childbearing potential
• Currently participating in an investigational drug or another device study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 50 centers

• Banner University Medical Center — Phoenix
• University of California Los Angeles — Los Angeles
• Sutter Medical Center — Sacramento
• Kaiser Permanente San Francisco — San Francisco
• Stanford University Medical Center — Stanford
• UC Health Northern Colorado/Medical Center of the Rockies — Loveland
• Hartford Hospital — Hartford
• JFK Medical Center/ Atlantic Clinical Research Collaborative — Atlantis
• … and 42 more centers

Canada · 1 center

• St. Paul's Hospital, Providence Health Care — Vancouver

Identifiers

NCT: NCT03003299 · 2015-08 AVIV

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗