Aortic Valve Stenosis
Conditions
Brief summary
The objective of the REPRISE EDGE study is to confirm the acute performance and safety of the LOTUS Edge™ Valve System when used with the Lotus™ or iSleeve™ Introducer Set for transcatheter aortic valve implantation (TAVI) in symptomatic patients with severe calcific aortic stenosis who are considered high risk for surgical valve replacement.
Detailed description
This clinical study is a prospective, single-arm study designed to demonstrate that the acute performance and safety of the LOTUS Edge Valve System when used with the iSleeve or Lotus Introducer Set are consistent with the results of the commercially approved Lotus Valve System used in the REPRISE II study, when delivered and deployed in symptomatic subjects who have severe calcific aortic valve stenosis and who are at high risk for surgical aortic valve replacement (SAVR).
Interventions
DEVICELOTUS Edge Valve System
Transcatheter Aortic Valve Implantation (TAVI) with the LOTUS Edge™ Valve System when used with the Lotus™ or iSleeve™ Introducer Set
Sponsors
Boston Scientific Corporation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject is ≥70 years of age. 2. Subject has documented calcific native aortic valve stenosis with an initial aortic valve area (AVA) of \<1.0 cm2 (or AVA index of \<0.6 cm2/m2) and either a mean pressure gradient \>40 mm Hg or a jet velocity \>4 m/s, as measured by echocardiography and/or invasive hemodynamics. Note: In cases of low flow, low gradient aortic stenosis dobutamine can be used to assess the grade of aortic stenosis (maximum dobutamine dose of 20 mcg/kg/min recommended)c; the subject may be enrolled if echocardiographic criteria are met with this augmentation. 3. Subject has a documented aortic annulus size between ≥20 mm and ≤27 mm based on pre-procedure diagnostic imaging. 4. Subject has symptomatic aortic valve stenosis with NYHA Functional Class ≥ II. 5. Subject is considered high risk for surgical valve replacement based on at least one of the following: * STS score ≥8%, and/or * Agreement by the heart team (which must include an in-person evaluation by an experienced cardiac surgeon) that subject is at high operative risk of serious morbidity or mortality with surgical valve replacement. 6. Heart team (which must include an experienced cardiac surgeon) assessment that the subject is likely to benefit from valve replacement 7. Subject (or legal representative) understands the study requirements and the treatment procedures, and provides written informed consent. 8. Subject, family member and/or legal representative agree(s) and subject is capable of returning to the study hospital for all required scheduled follow up visits.
Exclusion criteria
1. Subject has a congenital unicuspid or bicuspid aortic valve. 2. Subject with an acute myocardial infarction within 30 days of the index procedure (defined as Q-wave MI or non-Q-wave MI with total CK elevation ≥ twice normal in the presence of CK-MB elevation and/or troponin level elevation). 3. Subject has had a cerebrovascular accident or transient ischemic attack within the past 6 months, or has any permanent neurologic defect prior to study enrollment. 4. Subject is on dialysis or has serum creatinine level \>3.0 mg/dL or 265 µml/L. 5. Subject has a pre-existing prosthetic aortic or mitral valve. 6. Subject has \>3+ mitral regurgitation, \>3+ aortic regurgitation or \>3+ tricuspid regurgitation. 7. Subject has a need for emergency surgery for any reason. 8. Subject has a history of endocarditis within 12 months of index procedure or evidence of an active systemic infection or sepsis. 9. Subject has echocardiographic evidence of new intra-cardiac vegetation or intraventricular or paravalvular thrombus requiring intervention. 10. Subject has Hgb \<9 g/dL, platelet count \<50,000 cells/mm3 or \>700,000 cells/mm3, or white blood cell count \<1,000 cells/mm3. 11. Subject requires chronic anticoagulation therapy after the implant procedure and cannot be treated with warfarin (other anticoagulants are not permitted in the first month) for at least 1 month concomitant with either aspirin or clopidogrel. Note: An alternative P2Y12 inhibitor may be prescribed if subject is allergic to or intolerant of clopidogrel 12. Subject has had a gastrointestinal bleed requiring hospitalization or transfusion within the past 3 months, or has other clinically significant bleeding diathesis or coagulopathy that would preclude treatment with required antiplatelet regimen, or will refuse transfusions. 13. Subject has known hypersensitivity to contrast agents that cannot be adequately pre-medicated, or has known hypersensitivity to aspirin, all thienopyridines, heparin, nickel, titanium, or polyurethanes. 14. Subject has a life expectancy of less than 12 months due to non-cardiac, co-morbid conditions based on the assessment of the investigator at the time of enrollment. 15. Subject has hypertrophic obstructive cardiomyopathy. 16. Subject has any therapeutic invasive cardiac procedure within 30 days prior to the index procedure (except for balloon aortic valvuloplasty and pacemaker implantation which are allowed). 17. Subject has untreated coronary artery disease, which in the opinion of the treating physician, is clinically significant and requires revascularization. 18. Subject has documented left ventricular ejection fraction \<30%. 19. Subject is in cardiogenic shock or has hemodynamic instability requiring inotropic support or mechanical support devices. 20. Subject has severe vascular disease that would preclude safe access (e.g., aneurysm with thrombus that cannot be crossed safely, marked tortuosity, significant narrowing of the abdominal aorta, severe unfolding of the thoracic aorta, or symptomatic carotid or vertebral disease). 21. Subject has arterial access that is not acceptable for the LOTUS Edge delivery system and its compatible Lotus or iSleeve Introducers as defined in the Directions For Use, or severe iliofemoral tortuosity or calcification that would prevent safe placement of either introducer sheath. 22. Current problems with substance abuse (e.g., alcohol, etc.). 23. Subject is participating in another investigational drug or device study that has not reached its primary endpoint. 24. Subject does not have a permanent pacemaker but has a class I or II indication for pacemaker implantation (based on the latest available ESC guidelines).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean aortic valve pressure gradient | At discharge from hospital or at 7 days post-procedure (whichever comes first) | Mean aortic valve pressure gradient as measured by echocardiography and assessed by an independent core laboratory. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Technical success | Immediately post-procedure (patient discharged from operative room) | Defined as successful vascular access, delivery, and deployment of a Lotus Valve; successful retrieval with the delivery system; and correct positioning of a single Lotus Valve in the proper anatomical location (reported as percent of subjects implanted with a Lotus Valve). Reported as percent of subjects. |
| Effective orifice area | At discharge from hospital or at 7 days post-procedure (whichever comes first) | Effective orifice area as measured by echocardiography and assessed by an independent core laboratory |
| Successful repositioning of the study valve if repositioning is attempted | Immediately post-procedure (patient discharged from operative room) | — |
| Successful retrieval of the study valve if retrieval is attempted | Immediately post-procedure (patient discharged from operative room) | — |
| Grade of paravalvular aortic regurgitation | At discharge from hospital or at 7 days post-procedure (whichever comes first) | Grade of paravalvular aortic regurgitation as measured by echocardiography and assessed by an independent core laboratory |
Other
| Measure | Time frame | Description |
|---|---|---|
| Repeat procedure for valve-related dysfunction (surgical or interventional therapy) | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Hospitalization for valve-related symptoms or worsening congestive heart failure (New York Hear Association [NYHA] class III or IV) | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| New permanent pacemaker implantation resulting from new or worsened conduction disturbances (including new left bundle branch block [LBBB] and third degree atrioventricular block) | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| New onset of atrial fibrillation or atrial flutter | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Coronary obstruction | ≤72 hours post index procedure | — |
| Ventricular septal perforation | ≤72 hours post index procedure | — |
| Mitral apparatus damage | ≤72 hours post index procedure | — |
| Cardiac tamponade | ≤72 hours post index procedure | — |
| Prosthetic aortic valve malpositioning, including valve migration, valve embolization, or ectopic valve deployment | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Transcatheter aortic valve (TAV)-in-TAV deployment | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Mortality: all-cause, cardiovascular, and non-cardiovascular | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Prosthetic aortic valve endocarditis | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Prosthetic aortic valve performance: effective orifice area | 30 days, 6 months, and 1 year post procedure | Measured by transthoracic echocardiography (TTE) and assessed by an independent core laboratory |
| Prosthetic aortic valve performance: mean pressure gradient | 30 days, 6 months, and 1 year post procedure | Measured by transthoracic echocardiography (TTE) and assessed by an independent core laboratory |
| Prosthetic aortic valve performance: aortic valve regurgitation | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | Measured by transthoracic echocardiography (TTE) and assessed by an independent core laboratory |
| Prosthetic aortic valve performance: peak gradient | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | Measured by transthoracic echocardiography (TTE) and assessed by an independent core laboratory |
| Prosthetic aortic valve performance: peak velocity | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | Measured by transthoracic echocardiography (TTE) and assessed by an independent core laboratory |
| Functional status as evaluated by New York Heart Association (NYHA) classification | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Neurological status: National Institutes of Health Stroke Scale (NIHSS) | At discharge and 1 year | — |
| Neurological status: Modified Rankin Scale (mRS) | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Prosthetic aortic valve thrombosis | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Stroke: disabling and non-disabling | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Myocardial infarction (MI): periprocedural (≤72 hours post index procedure) and spontaneous (>72 hours post index procedure) | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Bleeding: life-threatening (or disabling) and major | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Acute kidney injury based on the AKIN System Stage 3 (including renal replacement therapy) or Stage 2 | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
| Major vascular complication | At discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, and 1 year post procedure | — |
Countries
Denmark, France, Sweden
Outcome results
None listed