Transcatheter Aortic Valve Replacement
Conditions
Keywords
aortic stenosis
Brief summary
This study was designed to preliminary verify the safety and of efficacy of SinocrownTM Transcatheter Aortic Valve Replacement System With accessories in patients with symptomatic, calcified and severe aortic stenosis using objective performance criteria
Detailed description
This prospective, single-center, single-arm clinical trial was designed to preliminary confirm the safety and efficacy of SinocrownTM transcatheter aortic valve system with accessories. According to the inclusion and exclusion criteria, 10 patients were enrolled and implanted with SinocrownTM .Patients will been followed up 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years after valve implantation. The main follow-up included clinical symptoms and signs, cardiac ultrasound, etc. The primary endpoint was device success after TAVR, Secondary endpoints included procedural success, all-cause mortality, myocardial infarction, disabling stroke, severe bleeding, acute kidney injury, permanent pacemaker implantation, vascular complications, other complication, MACCEs, valvular function , cardiac function improvement, quality of life of patients.
Interventions
DEVICESinocrownTM Transcatheter Aortic Valve Replacement System
Subjects receiving SinocrownTM Transcatheter Aortic Valve Replacement System of Lepu Medical
Sponsors
Lepu Medical Technology (Beijing) Co., Ltd.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 65 years ; 2. Autologous degenerative aortic stenosis（evaluated by echocardiography: transaortic valve pressure gradient ≥40mmHg , or transaortic valve blood flow rate ≥4m/s, or aortic Valve area\<1.0cm2, or AVA \<0.5cm2 /m2） 3. Patients with aortic annulus size≥17.5mm and ≤29mm (echocardiography measurement); 4. The diameter of the ascending aorta of the patient was \< 45mm. 5. Appear obvious symptoms caused by aortic stenosis, NYHA class Ⅱ to IV; 6. Subject or subject's legal representative have been informed of the nature of the study, agrees to participate and has signed the approved consent form. 7. Subjects are willing to accept all clinical follow-up. 8. The cardiologist and cardiac surgeon evaluated the subject as unsuitable for surgical treatment (the risk of death or irreversible complications within 30 days after operation is expected to be above 50% , or contraindicated comorbidities such as prior chest radiotherapy, liver failure, diffuse severe calcification of the aorta, extreme weakness, etc.). Or Moderate or higher surgical risk (STS score ≥ 4%).
Exclusion criteria
1. defined as Q-wave myocardial infarction or non-Q-wave myocardial infarction with CK-MB level ≥ 2 times the upper limit of normal value and / or Tn increase. 2. Subjects with congenital unicuspid, without calcification. 3. Any therapeutic or traumatic cardiac surgery within 30 days (within 3 months in case of drug-eluting stents implantation) 4. The patient's heart has been implanted with other artificial heart valves, artificial rings, or severe mitral annulus calcification (MAC), severe (\> 3 +) mitral insufficiency. 5. Hematological abnormalities, including leukopenia (WBC\<3×109/L), acute anemia (HB \<90g/L), thrombocytopenia (PLT\<50×109/L), bleeding constitution and coagulopathy ； 6. Subjects with hemodynamic instability, requiring continuous mechanical heart assistance. 7. Subjects who need emergency surgery for any reason; 8. Hypertrophic cardiomyopathy with or without obstruction; 9. Severe left ventricular dysfunction, left ventricular ejection fraction (LVEF) \<20%; 10. The echocardiogram indicates the presence of a thrombus or vegetation; 11. A history of active peptic ulcer or upper gastrointestinal bleeding within 3 months; 12. Are allergic to nickel titanium alloys or contrast agents, and cannot tolerate anticoagulation and antiplatelet therapy; 13. Cerebrovascular accident occurred within 6 months, including transient ischemic attack; 14. renal insufficiency(creatinine\> 3.0mg/dL) and/or end-stage renal disease requiring Renal dialysis; 15. Life expectancy\< 12 months; 16. Significant aortic diseases, including abdominal aortic or thoracic aortic aneurysm(defined as maximum lumen diameter \> 50mm, obvious distortion), atherosclerosis of the aortic arch(especially bulge with thickness \> 5mm or ulceration), narrowing of the abdominal or thoracic aorta(especially calcification and irregular surface), and severe curvature of the thoracic aorta; 17. The iliac-femoral artery cannot be inserted with a guide sheath of 22F or above, such as severely obstructed with calcification, severely tortuous or vessel diameter less than 6mm; 18. Screening participant who is participating in other drug or medical device clinical trials; 19. Active infective endocarditis or other active infections; 20. Anatomically, the approach or aortic root is not suitable for TAVR (such as a high risk of coronary artery occlusion). 21. Other conditions considered by the investigator to be inappropriate for participation in this clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| device success | immediate post-surgical | Immediate postoperative device success was defined as : successfully loading the valve into the delivery system, sending it to the target site through the delivery system, accurately releasing the artificial aortic valve and completely withdrawing the delivery system (valve orifice area \> 1.2cm2, mean aortic gradient\< 20mmhg or maximal aortic valve velocity \< 3 m/ s, and there is no moderate or severe valve stenosis) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All-cause mortality | immediate post-surgical, 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | including cardiac, non-cardiac and unexplained deaths |
| Myocardial infarction | immediate post-surgical, 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | Rate of patients with myocardial infarction |
| Rate of disabling stroke | 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | Disabling stroke was defined as mRS ≥ 2, and the mRS score increased by more than 1 point compared with the last visit |
| Rate of Severe bleeding(life-threatening or disabling) | 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | Severe degree was defined as type 3a or above（according to BARC） |
| acute kidney injury | 7 days after procedure/prior to discharge, 30 days after procedure | Rate of patients with acute kidney injury |
| permanent pacemaker implantation | 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | Rate of patients implanted with permanent pacemaker |
| Procedural success | immediate post-surgical | Device success without death and aortic valve reintervention during operation |
| other operative complication | immediate post-surgical, 7 days after procedure/prior to discharge | including conversion to surgery, unexpected cardiopulmonary mechanical assistance, coronary artery occlusion, ventricular septal perforation, mitral valve injury or loss of function, pericardial tamponade, endocarditis, valve thrombosis, valve ectopic (displacement, embolization, misrelease), and so on. |
| The incidence of major adverse cardiovascular and cerebrovascular events during the trial(MACCEs) | immediate post-surgical, 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months, 2 years, 3 years, 4 years and 5 years | Incidence of MACCEs (including mortality, stroke, myocardial infarction, reoperation, arrhythmias and conduction blocks) during the trial. |
| Valve and heart function | immediate post-surgical, 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months | Doppler echocardiography was used to evaluate the valve performance at each follow-up point, including valve orifice area, mean aortic gradient, degree of valve regurgitation, left ventricular ejection fraction LVEF, end diastolic left ventricular inner diameter LVEDd, moderate or above perivalvular leakage PVL, and degree of aortic stenosis. |
| Cardiac function improvement | 7 days after procedure/prior to discharge, 30 days, 6 months, 12 months | Cardiac function improvement is accessed by NYHA cardiac function classification increases from baseline to discharge, 30 days, 6 months, 12 months |
| Quality of life of patients | 30 days, 6 months, 12 months | Quality of Life of patients accessed by EuroQol-5 Dimensions (EQ-5D) Questionnaire. The higher scores mean a better health state. Recording changes from baseline to 30 days, 6 months, 12 months |
| vascular complications | immediate post-surgical, 7 days after procedure/prior to discharge | Vascular complications mainly include dissection, occlusion, rupture and bleeding of access vessels. |
Countries
China
Outcome results
None listed