Aortic Stenosis
Conditions
Brief summary
To assess the safety and clinical performance of the CoreValve™ Evolut R™ System.
Detailed description
The study objectives are to assess the safety and clinical performance of the CoreValve™ Evolut R™ System in patients with severe symptomatic aortic stenosis who are considered at high through extreme risk for surgical aortic valve replacement. These objectives will be accomplished by a prospective clinical study involving up to 60 implanted subjects among up to six study centers.
Interventions
CoreValve™ Evolut R™ System which consists of the Evolut R™ Transcatheter Aortic Valve (26 & 29 mm sizes), EnVeo R™ Delivery Catheter System with Enveo InLine™ Sheath, and EnVeo R™ Loading System
Sponsors
Study design
Eligibility
Inclusion criteria
1. Severe aortic stenosis, defined as aortic valve area of \< 1.0 cm2 (or aortic valve area index of \< 0.6 cm2/m2) by the continuity equation, AND mean gradient \> 40 mmHg or maximal aortic valve velocity \> 4.0 m/sec by resting echocardiogram. 2. Estimated 30 day mortality risk of \> 15% by study center Heart Team assessment,33 OR at least two cardiovascular surgeons from the study center deny surgery because of prohibitive operative risk, estimated to be a combined \>50% risk of irreversible mortality or morbidity. 3. Symptoms of aortic stenosis, and NYHA Functional Class II or greater. 4. The subject meets the legal minimum age to provide informed consent based on local regulatory requirements, and has provided written informed consent as approved by the EC/IRB of the respective clinical site. 5. The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.
Exclusion criteria
Clinical
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All-cause Mortality Rate at 30 Days | 30 days | The All-cause mortality rate at 30 days per the VARC II recommendation of clinical endpoints for TAVI. More specifically: Cardiovascular mortality (Any of the following criteria) * Death due to proximate cardiac cause (e.g. myocardial infarction, cardiac tamponade, worsening heart failure) * Death caused by non-coronary vascular conditions such as neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular disease * All procedure-related deaths, including those related to a complication of the procedure or treatment for a complication of the procedure * All valve-related deaths including structural or non-structural valve dysfunction or other valve-related adverse events * Sudden or unwitnessed death * Death of unknown cause Non-cardiovascular mortality * Any death in which the primary cause of death is clearly related to another condition (e.g. trauma, cancer, suicide) |
| Stroke Rate (Disabling and Non-disabling) at 30 Days | 30 days | The Stroke rate (disabling and non-disabling) at 30 days per the VARC II definitions. Stroke is defined as an acute episode of focal or global neurological dysfunction caused by the brain, spinal cord, or retinal vascular injury as a result of haemorrhage or infarction. Stroke may be classified as ischaemic or haemorrhagic with appropriate subdefinitions. Ischaemic stroke is defined as an acute episode of focal cerebral, spinal, or retinal dysfunction caused by infarction of central nervous system tissue. Haemorrhagic stroke is defined as an acute episode of focal or global cerebral or spinal dysfunction caused by intraparenchymal, intraventricular, or subarachnoid haemorrhage. A stroke may be classified as 'undetermined' if there is insufficient information to allow the categorization as ischaemic or haemorrhagic. |
| Device Success Rate at 24 Hours to Seven Days | 24 hours to seven days | 1. Device success rate at 24 hours to seven days, defined as: * Absence of procedural mortality, AND * Correct positioning of a single prosthetic heart valve into the proper anatomical location, AND * Intended performance of the prosthetic heart valve, defined as the absence of patient-prosthesis-mismatch and mean aortic valve gradient less than 20 mmHg (or peak velocity \< 3 m/sec), AND absence of moderate or severe prosthetic valve regurgitation. 2. The percentage of subjects with no more than mild aortic regurgitation at early post procedure echocardiogram (24 hours through seven days). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - • Effective Orifice Area (EOA) | 30 days | Effective orifice area |
| VARC II Combined Safety Endpoint at 30 Days | 30 days | The VARC II Combined Safety Endpoint at 30 days includes the following components: All-Cause Mortality, All Stroke, Life Threatening or Disabling Bleeding, Acute Kidney Injury: Stage 2 or 3, Coronary Artery Obstruction, Major Vascular Complication, and Valve-Related Dysfunction Requiring Repeat Procedure. |
| Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy. | Day 1 | Resheath or Recapture success rate (when attempted), where successful recapture is defined as Evolut R™ TAV (including the frame) is fully resheathed into the capsule of the delivery catheter, as verified by fluoroscopy. Resheathing or recapturing of the TAV was attempted on 15 subjects. |
| Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | 30 days | Degree of Total prosthetic valve regurgitation (transvalvular & paravalvular) |
| Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | 30 days | The Individual components of the VARC II composite safety endpoint at 30 days per the Kaplan Meier Event Rate (%). |
| Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Mean Gradient | 30 days | The hemodynamic performance will be measured by the Mean Prosthetic Valve Gradient for 59 subjects, measured with the Doppler echocardiography. |
Countries
Australia, New Zealand, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| The CoreValve™ Evolut R TAV™ System CoreValve™ Evolut R™ System which consists of the Evolut R™ Transcatheter Aortic Valve (26 & 29 mm sizes), EnVeo R™ Delivery Catheter System with Enveo InLine™ Sheath, and EnVeo R™ Loading System
The CoreValve™ Evolut R TAV™ system: CoreValve™ Evolut R™ System which consists of the Evolut R™ Transcatheter Aortic Valve (26 & 29 mm sizes), EnVeo R™ Delivery Catheter System with Enveo InLine™ Sheath, and EnVeo R™ Loading System | 60 |
| Total | 60 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Missed 30 day visit | 1 |
Baseline characteristics
| Characteristic | The CoreValve™ Evolut R TAV™ System |
|---|---|
| Age, Continuous | 82.8 years STANDARD_DEVIATION 6.1 |
| Body Surface Area (BSA) | 1.7 m² STANDARD_DEVIATION 0.2 |
| Logistic EuroScore | 20.5 percent risk for cardiac surgery STANDARD_DEVIATION 12.5 |
| NYHA Class NYHA I | 0 participants |
| NYHA Class NYHA II | 19 participants |
| NYHA Class NYHA III | 36 participants |
| NYHA Class NYHA IV | 5 participants |
| Region of Enrollment Australia | 25 participants |
| Region of Enrollment New Zealand | 6 participants |
| Region of Enrollment United Kingdom | 29 participants |
| Sex: Female, Male Female | 40 Participants |
| Sex: Female, Male Male | 20 Participants |
| STS Score | 7.0 percent of risk for cardiac surgery STANDARD_DEVIATION 3.7 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 60 / 60 |
| serious Total, serious adverse events | 40 / 60 |
Outcome results
All-cause Mortality Rate at 30 Days
The All-cause mortality rate at 30 days per the VARC II recommendation of clinical endpoints for TAVI. More specifically: Cardiovascular mortality (Any of the following criteria) * Death due to proximate cardiac cause (e.g. myocardial infarction, cardiac tamponade, worsening heart failure) * Death caused by non-coronary vascular conditions such as neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular disease * All procedure-related deaths, including those related to a complication of the procedure or treatment for a complication of the procedure * All valve-related deaths including structural or non-structural valve dysfunction or other valve-related adverse events * Sudden or unwitnessed death * Death of unknown cause Non-cardiovascular mortality * Any death in which the primary cause of death is clearly related to another condition (e.g. trauma, cancer, suicide)
Time frame: 30 days
Population: All implanted subjects at 30 days.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Implanted Subjects | All-cause Mortality Rate at 30 Days | 0.0 percentage of participants |
Device Success Rate at 24 Hours to Seven Days
1. Device success rate at 24 hours to seven days, defined as: * Absence of procedural mortality, AND * Correct positioning of a single prosthetic heart valve into the proper anatomical location, AND * Intended performance of the prosthetic heart valve, defined as the absence of patient-prosthesis-mismatch and mean aortic valve gradient less than 20 mmHg (or peak velocity \< 3 m/sec), AND absence of moderate or severe prosthetic valve regurgitation. 2. The percentage of subjects with no more than mild aortic regurgitation at early post procedure echocardiogram (24 hours through seven days).
Time frame: 24 hours to seven days
Population: All implanted subjects at 30 days.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Overall Device Success | 78.6 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Absence of Procedural Mortality | 100.0 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Correct Positioning of Single Valve | 98.3 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Intended Performance of Prosthetic Heart Valve | 80.0 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Absence of Patient Prosthesis Mismatch | 83.6 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Mean Gradient < 20mmHg or Peak Velocity < 3m/sec | 98.3 percentage of participants |
| All Implanted Subjects | Device Success Rate at 24 Hours to Seven Days | Absence of Mod. or Severe Prosthetic Regurgitation | 93.3 percentage of participants |
Stroke Rate (Disabling and Non-disabling) at 30 Days
The Stroke rate (disabling and non-disabling) at 30 days per the VARC II definitions. Stroke is defined as an acute episode of focal or global neurological dysfunction caused by the brain, spinal cord, or retinal vascular injury as a result of haemorrhage or infarction. Stroke may be classified as ischaemic or haemorrhagic with appropriate subdefinitions. Ischaemic stroke is defined as an acute episode of focal cerebral, spinal, or retinal dysfunction caused by infarction of central nervous system tissue. Haemorrhagic stroke is defined as an acute episode of focal or global cerebral or spinal dysfunction caused by intraparenchymal, intraventricular, or subarachnoid haemorrhage. A stroke may be classified as 'undetermined' if there is insufficient information to allow the categorization as ischaemic or haemorrhagic.
Time frame: 30 days
Population: All implanted subjects at 30 days.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Implanted Subjects | Stroke Rate (Disabling and Non-disabling) at 30 Days | 0.0 percentage of participants |
Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days
The Individual components of the VARC II composite safety endpoint at 30 days per the Kaplan Meier Event Rate (%).
Time frame: 30 days
Population: The number of subjects analyzed at 30 days.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | All Stroke | 0.0 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Combined Safety Endpoint | 13.3 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | All Cause Mortality | 0.0 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Life Threatening or Disabling Bleeding | 5.0 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Acute Kidney Injury: Stage 2 or 3 | 1.7 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Coronary Artery Obstruction | 0.0 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Major Vascular Complication | 8.3 percentage of probability |
| All Implanted Subjects | Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days | Valve-Related Dysfunct. Requiring Repeat Procedure | 0.0 percentage of probability |
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - • Effective Orifice Area (EOA)
Effective orifice area
Time frame: 30 days
Population: All implanted subjects who had echos at the 30 day visit, which were 58 subjects, only 54 of the echos were able to measure the EOA for those subjects.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - • Effective Orifice Area (EOA) | 1.9 cm² | Standard Deviation 0.5 |
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Mean Gradient
The hemodynamic performance will be measured by the Mean Prosthetic Valve Gradient for 59 subjects, measured with the Doppler echocardiography.
Time frame: 30 days
Population: All implanted subjects who had echos at the 30 day visit, which were 58 subjects, only 57 of the echos were able to measure the Mean Gradient for those subjects.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Mean Gradient | 8.1 mmHg | Standard Deviation 3.3 |
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular)
Degree of Total prosthetic valve regurgitation (transvalvular & paravalvular)
Time frame: 30 days
Population: All implanted subjects who had echos at the 30 day visit, which were 58 subjects, and 58 of the echos were able to measure the Total Aortic Regurgitation for those subjects.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | None | 8.6 percentage of participants |
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | Trace | 22.4 percentage of participants |
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | Mild | 63.8 percentage of participants |
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | Moderate | 5.2 percentage of participants |
| All Implanted Subjects | Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular) | Severe | 0.0 percentage of participants |
Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy.
Resheath or Recapture success rate (when attempted), where successful recapture is defined as Evolut R™ TAV (including the frame) is fully resheathed into the capsule of the delivery catheter, as verified by fluoroscopy. Resheathing or recapturing of the TAV was attempted on 15 subjects.
Time frame: Day 1
Population: Subjects who had either a resheath or recapture attempt at implant and the success rate for each resheathing, or recapturing attempts of the valve at the implant.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Implanted Subjects | Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy. | Success rate for Resheath or Recapture | 100.0 percentage of successful attempts |
| All Implanted Subjects | Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy. | Success rate for Resheath | 100.0 percentage of successful attempts |
| All Implanted Subjects | Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy. | Success rate for Recapture | 100.0 percentage of successful attempts |
VARC II Combined Safety Endpoint at 30 Days
The VARC II Combined Safety Endpoint at 30 days includes the following components: All-Cause Mortality, All Stroke, Life Threatening or Disabling Bleeding, Acute Kidney Injury: Stage 2 or 3, Coronary Artery Obstruction, Major Vascular Complication, and Valve-Related Dysfunction Requiring Repeat Procedure.
Time frame: 30 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Implanted Subjects | VARC II Combined Safety Endpoint at 30 Days | 13.3 percentage probability |