Congenital Heart Disease, Pulmonary Regurgitation, RVOT Anomaly, Tetrology of Fallot
Conditions
Brief summary
The purpose of this study is to further evaluate the safety and effectiveness of the Harmony™ TPV system. The Pivotal/CAS phases of the study have transitioned into a post-approval study to confirm the long-term functionality of transcatheter implantation of the Medtronic Harmony TPV.
Detailed description
The continued clinical experience addendum is a prospective, multi-center, non-randomized, interventional study to evaluate the safety and effectiveness of the Harmony TPV system. All implanted subjects will receive the Harmony TPV 22 or Harmony mTPV 25 device. This phase allows up to 45 subjects implanted with TPV 22 in the United States and Canada, and up to 84 subjects implanted with mTPV 25 in the United States. The Post Approval Phase (PAS) addendum is a prospective, multi-center, non-randomized, post-market study to evaluate the safety and effectiveness of the Harmony TPV system in the United States. All implanted subjects have been implanted with the Harmony TPV 22 or Harmony mTPV 25 device during the pivotal or CAS phase of the study. The PAS addendum extends follow-up from five years to ten years for consenting subjects.
Interventions
The Harmony™ TPV (Model NTPV0022) is comprised of a 22mm porcine pericardium valve, sewn to a polyester-covered nitinol frame. The Harmony TPV 25 and mTPV 25 (Model HTPV254952 and HTPV254252, respectively) is comprised of a 25mm porcine pericardium valve, sewn to a polyester covered asymmetrical hourglass nitinol frame with larger diameter inflow and outflow as well as shorter length compared to TPV 22 (Harmony TPV 25 Model HTPV254952 is not applicable for Continued Clinical Experience). The Harmony Delivery System (DS) for the TPV 22, TPV 25, and mTPV 25 (NTPVDS0022 and HTPVDS0025) are all 25 Fr delivery systems using a coil loading catheter.
Sponsors
Study design
Eligibility
Inclusion criteria
* Subject has severe pulmonary regurgitation as assessed via echocardiography or CMR determined PR fraction \>/= 30% * Subject has clinical indication for surgical placement of an RV-PA conduit or bioprosthetic pulmonary valve * Subject is willing to consent to participate
Exclusion criteria
* Patients with right ventricular outflow tract obstruction (RVOTO) lesions surgically treated with an RV-to-PA conduit implant * RVOT anatomy or morphology that is unfavorable for device anchoring * Positive pregnancy test * Life expectancy of less than 1 year
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Freedom From Procedure- or Device-related Mortality at 30 Days. | 30 days | The primary safety endpoint is point estimate of freedom from procedure or device-related mortality rate at 30 days post procedure. |
| Number of Participants With Acceptable Hemodynamic Function Composite at 6 Months | 6 months | Defined as: * Mean RVOT gradient as measured by continuous-wave Doppler ≤40 mmHg -AND- * Pulmonary regurgitant fraction as measured by magnetic resonance imaging \<20% |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Procedural Success at 30 Days | 30 days | Procedural success is defined as: * Device success at 30 days, and * None of the following device- or procedure-related serious adverse events: * Life-threatening major bleed * Major vascular or cardiac structural complications required unplanned reintervention or surgery * Stage 2 or 3 acute kidney injury (AKI) (includes new dialysis) * Pulmonary embolism * Severe heart failure (HF) or hypotension requiring IV inotrope, ultrafiltration, or mechanical circulatory support * Prolonged intubation \>48 hours |
| Freedom From TPV Dysfunction Out to 5 Years | 5 years (5 year data has an anticipated reporting date of April 2026) | TPV dysfunction is defined as any one of the following: * RVOT reoperation for device-related reasons * Catheter re-intervention of TPV * Hemodynamic dysfunction of the TPV (moderate or greater pulmonary regurgitation, and/or a mean RVOT gradient \>40 mmHg) |
| Number of Participants With Technical Success at Exit From Catheterization Lab/Operating Room (OR) | At exit from catheterization lab/operating room (OR) | Technical success at exit from catheterization lab/operating room (OR), as defined as: * No device- or procedural-related mortality, with * Successful access, delivery and retrieval of the delivery system, and * Deployment and correct positioning (including minor repositioning if needed) of the single intended device, and * No need for additional unplanned or emergency surgery or re-intervention related to the device or access procedure |
| Characterization of Quality of Life Scores Out to 5 Years | Baseline, 30 Day, 6 Month, 1 Year, 2 Year, 3 Year | Quality of life score over time will be assessed by the SF-36 at pre-implant, 1 month post-implant, 6 months post-implant, 1 year post-implant, 2 years post-implant, and 3 years. The analysis cohort will be the implanted \> 24 hours cohort. Minimum score of 0 and maximum score of 100 is possible. Higher values are considered to be a better outcome. |
| Characterization of Right Ventricle Remodeling Following TPV Implant | Baseline, 6 Month | Right ventricle remodeling will be assessed via CMR at pre-implant and 6 months post-implant. The analysis cohort will be implanted longer than 24 hours cohort. The characterization will be made using right ventricular end diastolic volume (ml). |
| Assessment of Safety | Ongoing | All procedure-related serious adverse events. All device-related serious adverse events. Death (all-cause, procedural, and device-related). |
| Device Success Out to 5 Years | 5 years | Device success is defined as: * No device- or procedural-related mortality, with * Original intended device in place, and * No additional surgical or interventional procedures related to access or the device since completion of the original procedure (i.e., exit from the catheterization lab), and * Intended performance of the device, as defined as: * Structural performance: No migration, embolization, detachment, major stent fracture, hemolysis, thrombosis, endocarditis, and * Hemodynamic performance: Relief of insufficiency (PR \< moderate) without producing the opposite (mean RVOT gradient \> 40 mmHg) as measured by continuous wave Doppler, and * Absence of para-device complications, as defined by: * PVL = moderate, or * Erosion, or * RVOT or PA rupture |
Countries
Canada, Japan, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Implanted Pivotal Harmony TPV Subjects This study is comprised of a single arm of subjects implanted with the Harmony TPV device during the pivotal study. | 50 |
| Total | 50 |
Baseline characteristics
| Characteristic | Implanted Pivotal Harmony TPV Subjects |
|---|---|
| Age, Continuous | 28.7 years STANDARD_DEVIATION 11.3 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 6 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants |
| Race (NIH/OMB) White | 40 Participants |
| Region of Enrollment Japan | 2 participants |
| Region of Enrollment United States | 48 participants |
| Sex: Female, Male Female | 19 Participants |
| Sex: Female, Male Male | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 50 |
| other Total, other adverse events | 33 / 50 |
| serious Total, serious adverse events | 3 / 50 |
Outcome results
Freedom From Procedure- or Device-related Mortality at 30 Days.
The primary safety endpoint is point estimate of freedom from procedure or device-related mortality rate at 30 days post procedure.
Time frame: 30 days
Population: The catheterized cohort consists of all subjects who undergo catheterization for possible implantation of the Harmony TPV. The primary safety endpoint population includes all subjects that were catheterized and also had evaluable data at 30 days. Two subjects were exited prior to the 30 day timepoint.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Catheterized Cohort | Freedom From Procedure- or Device-related Mortality at 30 Days. | 48 Participants |
Number of Participants With Acceptable Hemodynamic Function Composite at 6 Months
Defined as: * Mean RVOT gradient as measured by continuous-wave Doppler ≤40 mmHg -AND- * Pulmonary regurgitant fraction as measured by magnetic resonance imaging \<20%
Time frame: 6 months
Population: The implanted \>24 hours cohort consists of all subjects who have a Harmony TPV implanted which remains implanted for greater than 24 hours.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Catheterized Cohort | Number of Participants With Acceptable Hemodynamic Function Composite at 6 Months | 43 Participants |
Assessment of Safety
All procedure-related serious adverse events. All device-related serious adverse events. Death (all-cause, procedural, and device-related).
Time frame: Ongoing
Characterization of Quality of Life Scores Out to 5 Years
Quality of life score over time will be assessed by the SF-36 at pre-implant, 1 month post-implant, 6 months post-implant, 1 year post-implant, 2 years post-implant, and 3 years. The analysis cohort will be the implanted \> 24 hours cohort. Minimum score of 0 and maximum score of 100 is possible. Higher values are considered to be a better outcome.
Time frame: Baseline, 30 Day, 6 Month, 1 Year, 2 Year, 3 Year
Population: Number analyzed differs from overall number analyzed because subjects have either exited or have not yet completed that timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | Baseline | 80.5 score on a scale | Standard Deviation 25.6 |
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | 30 Day Follow-up | 90.2 score on a scale | Standard Deviation 15.6 |
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | 6 Month Follow-up | 94.6 score on a scale | Standard Deviation 8.8 |
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | 1 Year Follow-up | 91.6 score on a scale | Standard Deviation 14.9 |
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | 2 Year Follow-up | 94.4 score on a scale | Standard Deviation 11 |
| Catheterized Cohort | Characterization of Quality of Life Scores Out to 5 Years | 3 Year Follow-up | 98.3 score on a scale | Standard Deviation 4.1 |
Characterization of Quality of Life Scores Out to 5 Years
Quality of life score over time will be assessed by the SF-36 at 4 & 5 years. The analysis cohort will be the implanted \> 24 hours cohort. Minimum score of 0 and maximum score of 100 is possible. Higher values are considered to be a better outcome.
Time frame: 4 Year, 5 Year (4 & 5 year data has an anticipated reporting date of April 2026)
Characterization of Right Ventricle Remodeling Following TPV Implant
Right ventricle remodeling will be assessed via CMR at 2 years post- implant and 5 years post-implant. The analysis cohort will be implanted longer than 24 hours cohort. The characterization will be made using right ventricular end diastolic volume (ml).
Time frame: 2 Year, 5 Year (2 & 5 year data has an anticipated reporting date of April 2026)
Characterization of Right Ventricle Remodeling Following TPV Implant
Right ventricle remodeling will be assessed via CMR at pre-implant and 6 months post-implant. The analysis cohort will be implanted longer than 24 hours cohort. The characterization will be made using right ventricular end diastolic volume (ml).
Time frame: Baseline, 6 Month
Population: Subjects included in this analysis were those who were successfully implanted with a Harmony TPV for greater than 24 hours and had evaluable CMR data at the given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Catheterized Cohort | Characterization of Right Ventricle Remodeling Following TPV Implant | Pre-implant | 291.5 ml | Standard Deviation 57.4 |
| Catheterized Cohort | Characterization of Right Ventricle Remodeling Following TPV Implant | 6 Months | 223.0 ml | Standard Deviation 54.9 |
Device Success Out to 5 Years
Device success is defined as: * No device- or procedural-related mortality, with * Original intended device in place, and * No additional surgical or interventional procedures related to access or the device since completion of the original procedure (i.e., exit from the catheterization lab), and * Intended performance of the device, as defined as: * Structural performance: No migration, embolization, detachment, major stent fracture, hemolysis, thrombosis, endocarditis, and * Hemodynamic performance: Relief of insufficiency (PR \< moderate) without producing the opposite (mean RVOT gradient \> 40 mmHg) as measured by continuous wave Doppler, and * Absence of para-device complications, as defined by: * PVL = moderate, or * Erosion, or * RVOT or PA rupture
Time frame: 5 years
Freedom From TPV Dysfunction Out to 5 Years
TPV dysfunction is defined as any one of the following: * RVOT reoperation for device-related reasons * Catheter re-intervention of TPV * Hemodynamic dysfunction of the TPV (moderate or greater pulmonary regurgitation, and/or a mean RVOT gradient \>40 mmHg)
Time frame: 5 years (5 year data has an anticipated reporting date of April 2026)
Number of Participants With Procedural Success at 30 Days
Procedural success is defined as: * Device success at 30 days, and * None of the following device- or procedure-related serious adverse events: * Life-threatening major bleed * Major vascular or cardiac structural complications required unplanned reintervention or surgery * Stage 2 or 3 acute kidney injury (AKI) (includes new dialysis) * Pulmonary embolism * Severe heart failure (HF) or hypotension requiring IV inotrope, ultrafiltration, or mechanical circulatory support * Prolonged intubation \>48 hours
Time frame: 30 days
Population: The attempted implant cohort consists of all subjects who undergo catheterization and a Harmony TPV implantation was attempted (Harmony TPV is introduced into the subject's body).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Catheterized Cohort | Number of Participants With Procedural Success at 30 Days | 42 Participants |
Number of Participants With Technical Success at Exit From Catheterization Lab/Operating Room (OR)
Technical success at exit from catheterization lab/operating room (OR), as defined as: * No device- or procedural-related mortality, with * Successful access, delivery and retrieval of the delivery system, and * Deployment and correct positioning (including minor repositioning if needed) of the single intended device, and * No need for additional unplanned or emergency surgery or re-intervention related to the device or access procedure
Time frame: At exit from catheterization lab/operating room (OR)
Population: The attempted implant cohort consists of all subjects who undergo catheterization and a Harmony TPV implantation was attempted (Harmony TPV is introduced into the subject's body).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Catheterized Cohort | Number of Participants With Technical Success at Exit From Catheterization Lab/Operating Room (OR) | 45 Participants |