TRIcvalve biCAVal Valve System for Severe Tricuspid Regurgitation (TRICAV-I)

Official title

A Prospective, Multicenter Clinical Trial of the TricValve® Transcatheter Bicaval Valve System in Subjects With Severe Tricuspid Regurgitation - TRICAV-I Trial

Overview

The TricValve® Transcatheter Bicaval Valve System is a bicaval transcatheter tricuspid valve replacement system, which includes the TricValve® Transcatheter Bicaval Valve for superior vena cava (SVC) and the TricValve® Transcatheter Bicaval Valve for inferior vena cava (IVC). The TricValve® Transcatheter Bicaval Valves are pre-mounted into the TricValve® Delivery System which is used for percutaneous access and delivery of the TricValve® Transcatheter Bicaval Valve in the vena cava. The system is a single use, sterile device compatible with all the valve sizes. The prostheses are implanted percutaneously into the inferior and superior vena cava without disturbing the native tricuspid valve. The device is made of bovine pericardium leaflets sutured on a nitinol self-expanding stent system.

Detailed description

This is a prospective multicenter clinical investigation designed to evaluate the safety and effectiveness of the TricValve® Transcatheter Bicaval Valve System for improving outcomes in symptomatic subjects with severe TR deemed by the local Heart Team to be at high risk for tricuspid valve surgery.

Patients who meet all of the study inclusion criteria, will be treated with the TricValve System. After the intervention, patients will be followed up closely for 12 months. Long term safety and efficacy data will be collected annually up to 5 years.

Interventions

• Device TricValve® Transcatheter Bicaval Valve System
  The TricValve® Transcatheter Bicaval Valve System is a bicaval transcatheter tricuspid valve replacement system, which includes the TricValve® Transcatheter Bicaval Valve for superior vena cava (SVC) and the TricValve® Transcatheter Bicaval Valve for inferior vena cava (IVC). The system is a single use, sterile device compatible with all the valve sizes. The valves are premounted in the TricValve® Delivery System. The prostheses are implanted percutaneously into the inferior and superior vena ca

Primary outcome measures

• Mortality [Time frame: 1 Month and 12 Months]
• Stroke [Time frame: 1 Month]
• Pulmonary Embolism [Time frame: 1 Month]
• Valve Academic Research Consortium (VARC) type 2-4 bleeding complication [Time frame: 1 Month]
• Major vascular, access-related, or cardiac structural complication [Time frame: 1 Month]
• Stage 3 Acute Kidney Injury with increase in serum creatinine >300% (>3.0x increase) and/or serum creatinine ≥4.0mg/dL (≥354 μmol/L) with an acute increase of ≥ 0.5 mg/dL (≥44 μmol/L) [Time frame: 7 Days]
• Stage 4 Acute Kidney Injury requiring new temporary or permanent renal replacement therapy [Time frame: 1 Month]
• Emergency surgery or intervention related to the device/procedure complications [Time frame: 1 Month]
• Right Ventricular Assist Device (RVAD) implantation or heart transplant [Time frame: 12 Months]
• Tricuspid valve surgery or percutaneous tricuspid intervention [Time frame: 12 Months]

Secondary outcome measures (10)

• Technical success of device placement (at exit from procedure room) [Time frame: Intraprocedural]
• Device success within 30 days after device placement [Time frame: 1 Month]
• Procedural success (at 30 days) [Time frame: 1 Month]
• Mortality [Time frame: 12 Months]
• RVAD implantation or heart transplant [Time frame: 12 Months]
• Tricuspid valve surgery or percutaneous tricuspid intervention [Time frame: 12 Months]
• Heart Failure hospitalization or worsening Heart Failure (HF) which encompasses treatment with IV diuretics in the office or Emergency Department treatment during a <24-hour time period [Time frame: 12 Months]
• Kansas City Cardiomyopathy Questionnaire (KCCQ) Score [Time frame: 12 Months]
• New York Heart Association (NYHA class) [Time frame: 12 Months]
• Six Minute Walking Test (6MWT) [Time frame: 12 Months]

Eligibility criteria

Inclusion criteria

• Subject must be 18 years or older, at the time of signing the informed consent.
• Subjects has severe tricuspid regurgitation (TR), as determined by the qualifying transthoracic echocardiogram (TTE) confirmed by an echocardiography Core Lab.
• NYHA Class III-IVa (not on inotropes, IABP or LVAD) or heart failure (HF) admission in the past 6 months.
• Subject is adequately treated with optimal medical therapy (OMT) for heart failure per the local Heart Team for at least 30 days prior to the index procedure, including a diuretic.
• The local Heart Team and IEC determine that the patient is eligible for the TricValve procedure.
• For females of childbearing potential, negative pregnancy test.
• Capable of giving signed informed consent.

Exclusion criteria

• Subject had a recent MI, stroke or cardiovascular accident; underwent coronary artery bypass graft surgery, had a percutaneous coronary intervention or other major cardiovascular surgery within 90 days prior to TricValve implantation.
• Subject requires another planned major cardiac procedure, including left-sided transcatheter intervention or surgery (e.g. severe aortic stenosis, severe mitral regurgitation), coronary artery bypass or PCI or pulmonary valve correction. Please note that if closure of an ASD, iatrogenic ASD or PFO is performed, TricValve implantation can be performed 30 days after the intervention. Additionally, TricValve implantation can be performed 30 days after any Electrophysiology procedure (pacemaker, ICD, etc.).
• LVEF ≤ 30% on echocardiography.
• Evidence of intracardiac, inferior vena cava (IVC), or femoral venous mass, thrombus or vegetation.
• Tricuspid stenosis. (Per TVARC, echo criteria: TVA at least 1.5 cm2 or TVAi at least 0.9 cm2/m2 \[at least 0.75 if BMI >30 kg/m2\], DVI <2.2, mean gradient <5mm Hg); reduction of total tricuspid regurgitation to optimal (≤ mild \[1+\]) or acceptable (≤ moderate \[2+\]).
• Severe right ventricular dysfunction.
• Cardiac amyloidosis
• Pulmonary artery systolic pressure (PASP) >65 mmHg assessed with Echo Doppler and /or right heart catheterization.
• Lower extremity venous thrombosis and/or the presence of an IVC filter at the time of or 6 months prior to TricValve procedure.
• Hemodynamically significant pericardial effusion.
• Patient with refractory heart failure requiring advanced intervention (i.e. left ventricular assist device, transplantation) (ACC/ AHA/ ESC/ EACTS Stage D heart failure)
• Any known allergy or hypersensitivity to nitinol, bovine tissue or contrast media that cannot be adequately treated with pre-medication.
• Unable to tolerate anticoagulation/antiplatelet therapy
• Hemodynamic instability, cardiogenic shock, inotropic support, intra-aortic balloon pump or acute heart failure within 30 days prior to the TricValve procedure.
• Any known life-threatening condition with an estimated life span of at least 12 months.
• Platelet count < 75,000/mm3
• Child-Pugh Severity Class C (10-15 points).
• Severe renal insufficiency with estimated glomerular filtration rate (eGFR) ≤ 25 mL/min/1.73 m2 or requiring chronic renal replacement therapy at the time of enrollment.
• Endocarditis or active/ongoing infection requiring antibiotics.
• Unable to walk at least 60 meters in a 6minute walk test.
• Known bleeding or clotting disorders or patient refuses blood transfusion.
• Active gastrointestinal (GI) bleeding within 3 months of randomization.
• Presence of significant congenital heart disease including but not limited to hemodynamically significant atrial septal defect, RV dysplasia, and arrhythmogenic RV.
• Use or participation in other investigational device or drug study in which patient has not reached a primary endpoint to treat cardiovascular conditions related to the outcomes of the current study.
• Any other condition that would preclude ability to meet study requirements in the opinion of the investigator.
• Psychiatric/behavioral issues or other medical or social conditions that preclude valid consent and follow-up
• Pregnant or breastfeeding subjects and those who plan pregnancy during the clinical investigation follow-up period.

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 · 36 centers

• St. Joseph's Hospital and Medical Center — Phoenix
• Tucson Medical Center — Tucson
• Scripps Memorial Hospital La Jolla — San Diego
• UCSF — San Francisco
• Delray Medical Center — Delray Beach
• Largo Medical Center — Largo
• Tampa General Hospital — Tampa
• Endeavor Health, Glenbrook Hospital — Glenview
• … and 28 more centers

Publications

• Estevez-Loureiro R, Sanchez-Recalde A, Amat-Santos IJ, Cruz-Gonzalez I, Baz JA, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Salido-Tahoces L, Santos-Martinez S, Nunez JC, Moris C, Goliasch G, Jimenez-Quevedo P, Ojeda S, Cid-Alvarez B, Santiago-Vacas E, Jimenez-Valero S, Serrador A, Martin-Moreiras J, Strouhal A, Hengstenberg C, Zam PMID 35583363
• Amat-Santos IJ, Estevez-Loureiro R, Sanchez-Recalde A, Cruz-Gonzalez I, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Blasco-Turrion S, Sanchez-Luna JP, Revilla-Orodoea A, Redondo A, Zamorano JL, Puri R, Iniguez-Romo A, San Roman A. Right heart remodelling after bicaval TricValve implantation in patients with severe tricuspid regurgi PMID 37083622
• Abdul-Jawad Altisent O, Codina P, Puri R, Bayes-Genis A. Transcatheter bi-caval valve implantation (CAVI) significantly improves cardiac output: mechanistic insights following CardioMEMS(R) and TricValve(R) implantation. Clin Res Cardiol. 2022 Aug;111(8):966-968. doi: 10.1007/s00392-022-02029-8. Epub 2022 May 2. No abstract available. PMID 35499708
• Chandran K, Long A, Bishop J, Berman P, Matar F, Oliveira GH, Bezerra HG. First In-Man Experience With TricValve Transcatheter Bicaval Valve System in Left Ventricular Assist Device Heartmate II Patient for High-Risk Tricuspid Regurgitation. Circ Heart Fail. 2023 Jun;16(6):e010027. doi: 10.1161/CIRCHEARTFAILURE.122.010027. Epub 2023 Jun 6. No abstract available. PMID 37278243

Identifiers

NCT: NCT06137807 · CTP-TRIC-005

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗