Patients With Severe TrIcuspid Regurgitation After triCvALve System Implantation

Official title

Cardiovascular, Renal and haemodynamIc Outcomes in Patients With Severe TrIcuspid Regurgitation After triCvALve System Implantation: an International Registry - CRITICAL INTERNATIONAL REGISTRY

Overview

International Registry to collect patients with severe TR undergoing TricValve implantation from multiple Italian and European centers, aimed at: * Assessing the effect of TricValve implantation on cardiovascular and all-cause mortality, HF rehospitalization, renal function, functional capacity and quality of life. * Clarifying the haemodynamic effects of TricValve implantation and investigating their pathophysiological implications.

Detailed description

Study Design

Type of study: Non-profit, multi-center, observational, prospective cohort study (with retrospective inclusion of the first cases performed)

Patient population: 100 patients

Date of beginning of enrollment: April 1st, 2023 (plus inclusion of patients treated since 2022)

Duration of the study: 12 months

All patients enrolled will undergo serial evaluations (Figure 1).

* At Baseline we will collect (see eCRF):

* Clinical data regarding medical history, clinical status and medications; * Biohumoral data (blood and urine chemistry); * Haemodynamic data (Right Heart Catheterization); * Echocardiographic data including Comprehensive 2D and Doppler Transtoracic Echocardiography and Transoesophageal Echocardiography; * Anatomical data (Cardiac CT). * At the time of procedure we will collect (see eCRF):

* Procedural data including the occurrence of peri-procedural complications; * Haemodynamic data (Right Heart Catheterization). * At discharge we will collect (see eCRF):

* Clinical data regarding clinical status and medications; * Biohumoral data (blood and urine chemistry); * Echocardiographic data including comprehensive 2D and Doppler Transtoracic Echocardiography; * Peri-procedural data including the occurrence of peri-procedural complications. * At 30-day follow-up we will collect (see eCRF):

* Clinical data regarding medical history, clinical status and medications; * Biohumoral data (blood and urine chemistry); * Echocardiographic data including comprehensive 2D and Doppler Transtoracic Echocardiography; * At 6-month follow-up we will collect (see eCRF):

* Clinical data regarding medical history, clinical status and medications; * Biohumoral data (blood and urine chemistry); * Echocardiographic data including comprehensive 2D and Doppler transthoracic echocardiography; * Haemodynamic data (Right Heart Catheterization), if clinically indicated. * At 1-year follow-up we will collect (see eCRF):

* Clinical data regarding medical history, clinical status and medications; * Biohumoral data (blood and urine chemistry); * Echocardiographic data including Comprehensive 2D and Doppler Transtoracic Echocardiography; * Haemodynamic data (Right Heart Catheterization), if clinically indicated.

Interventions

• Device TricValve implantation
  TricValve implantation

Primary outcome measures

• The composite of all-cause mortality and HF rehospitalization at 6-month follow-up [Time frame: 6-month follow-up]

Secondary outcome measures (8)

• The composite of all-cause mortality and HF rehospitalization at 1-year follow-up [Time frame: 1-year follow-up]
• Cardiovascular mortality at 1-year follow-up [Time frame: 1-year follow-up]
• Number of HF rehospitalizations at 1-year follow-up [Time frame: 1-year follow-up]
• Number of unscheduled cardiology consultations resulting in changes in medical therapy at 6- month follow-up. [Time frame: 6- month follow-up]
• Change in New York Hearts Association (NYHA) functional class and change in Kansas City Cardiomyopathy Questionnaire (KCCQ) score at 6-month and 1-year follow-up. [Time frame: 6- month follow-up]
• Change in the dose of loop diuretics (in mg/day) at 6-month follow-up [Time frame: 6- month follow-up.]
• Progression of kidney disease, defined as the composite of end-stage kidney disease, a decrease in eGFR to <10 ml/min/1.73 m2, a decrease in eGFR ≥40% from baseline, and death from renal causes at 6-month follow-up. [Time frame: 6- month follow-up.]
• Change in 6MWD and in peak oxygen uptake (VO2) at 6-month follow-up. [Time frame: 6- month follow-up.]

Eligibility criteria

Inclusion criteria

• The subject must be 18 years of age or older
• The subject must be a patient with massive or torrential symptomatic tricuspid regurgitation demonstrated by echocardiography with significant backflow in the IVC and/or SVC and with a v-wave ≥ 25 mmHg as demonstrated by right heart catheterization (measured in the IVC and/or SVC 2-4 cm above/ below right atrium (RA) inflow) within 8 weeks prior to the implantation
• Suitable for TricValve Transcatheter Bicaval Valves System implantation according to anatomic criteria by computed tomography (CT)inserire la parte retrospettiva ossia i pazienti che già hanno avuto l'impianto
• The subjects must have severe, tricuspid regurgitation leading to New York Heart Association (NYHA) class III or IV
• Distance covered in 6-minute walk test (6MWT) ≥ 60m
• Patient/authorized legal guardian understands the nature of the procedure, is willing to comply with associated follow-up evaluations, and provides written informed consent Patient/patient's authorized legal guardian is geographically stable (or willing to return for required study follow-up) and understands and is willing to fulfil all of the expected requirements of the clinical protocol

Exclusion criteria

• Known significant intracardiac shunt (e.g. ventricular septal defect) or congenital structural heart disease based on heart team decision
• Requirement for other elective cardiac procedures e.g. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG) up to 90 days after the procedure or 30 days before the procedure
• Right ventricular failure (TAPSE ≤13 mm)
• Systolic pulmonary arterial pressure > 65 mmHg as assessed by Doppler echocardiography
• Life expectancy less than one year
• Cerebro-vascular event within the past 3 months
• History of mitral/tricuspid endocarditis within the last 12 months
• Patient has untreated significant left sided valvular heart disease which requires treatment (e.g. mitral regurgitation or stenosis, and aortic regurgitation or stenosis)
• Documented primary coagulopathy or platelet disorder, including thrombocytopenia (absolute platelet count <90k)
• Documented evidence of significant renal dysfunction (serum creatinine > 3.0mg/dl) or on any form of dialysis at time of screening within the last 4 weeks
• Contraindication or known allergy to device's components, anti-coagulation therapy with vitamin K antagonists or contrast media that cannot be adequately pre-treated
• Evidence of an acute myocardial infarction (AMI) ≤ 1 month (30 days)
• Currently participating in another study of an investigational drug or device that would directly impact the treatment or outcome of the current study

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

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Italy · 1 center

• Azienda Ospedaliero Universitaria Pisana — Pisa

Identifiers

NCT: NCT05820516 · CRITICAL

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗