Severe Tricuspid Valve Regurgitation, Tricuspid Regurgitation, Tricuspid Regurgitation Functional
Conditions
Keywords
MIA-T, severe TR, severe functional TR
Brief summary
Purpose of this clinical study is to demonstrate the safety and efficacy of MIA-T system in improving clinical outcomes in symptomatic patients with severe tricuspid regurgitation (TR grade ≥3) despite optimal medical therapy, who have been determined by the site's local heart team to be at intermediate or greater estimated risk for mortality and morbidity with tricuspid valve surgery.
Detailed description
A prospective, multi-center, randomized, controlled, pivotal study of the MIA Percutaneous Tricuspid Annuloplasty System (MIA-T) in symptomatic subjects with severe (≥3) TR despite optimal medical therapy. The study will randomize eligible subjects in two (2) cohorts at up to 40 sites.
Interventions
DEVICEMIA_T Device
MIA-T Device
Sponsors
Micro Interventional Devices
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Two cohorts One (1) cohort will randomize subjects at a 1:1 ratio against commercially available TEER Device (control group). One (1) cohort is a single arm cohort for patients deemed unfavorable for TEER and the local heart team determines the patient is not optimal for valve replacement.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subject has severe functional TR (≥ 3). Note: If any cardiac procedure(s) occur after eligibility was determined, TR severity will need to be re-assessed 30 days after any cardiac procedure(s) * In the judgment of the site's local heart team patient is at intermediate or greater risk for morbidity & mortality with tricuspid valve surgery, and has been adequately treated per applicable standards with optimized medical therapy for the treatment of TR (e.g. diuretics) and stable for at least 30 days prior to enrollment. * New York Heart Association (NYHA) Functional Class II, III or ambulatory class IV
Exclusion criteria
* Systolic pulmonary artery pressure (sPAP) \> 70 mmHg or \> 5 wood units (WU) despite vasodilator therapy * Severe uncontrolled hypertension Systolic Blood Pressure (SBP) ≥ 180 mmHg and/or Diastolic Blood Pressure (DBP) ≥ 110 mm Hg * Previous tricuspid valve repair or replacement (transcatheter or surgical approach) * Subjects with concomitant left-sided valve disease will have the option of receiving a left-sided intervention (e.g. TMVR or TAVR) and waiting 60 days prior to being reassessed for the study * Myocardial infarction (MI), known unstable angina, symptomatic coronary artery disease (CAD) where revascularization is possible within 60 days prior to enrollment * Anatomy that precludes safe placement of anchors around the annulus * Hemodynamic instability defined as systolic pressure \< 90 mmHg requiring pressor support within the last 30 days Echo Criteria - * Subject has severe functional TR (determined by the ICL). Note: If any cardiac procedure(s) occur after eligibility was determined, TR severity will need to be re-assessed 30 days after any cardiac procedure(s) * No presence of Cardiac Implantable Electronic Devices (CIED) leads causing the TR * No significant annular calcification * Left Ventricular Ejection Fraction (LVEF) ≥ 20%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary Efficacy Endpoint | 12 months | Composite endpoint of the following components: * All-cause mortality * Tricuspid valve intervention (percutaneous or surgery) * Heart Failure Hospitalization |
| Primary Safety Endpoint | 30 days | Freedom from MAE, including: * Cardiovascular mortality * New Onset Renal Failure * Endocarditis requiring surgery * Non-elective cardiovascular surgery for device-related AE post-index procedure |
Secondary
| Measure | Time frame |
|---|---|
| Freedom from heart failure hospitalizations at all study timepoints | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Clinical Success Rate | 1Month |
| Intraprocedural Success Rate | 1Month |
| Freedom from Major Adverse Events (MAE) at all study time points. | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Prevalence of Device or Procedure-Related Adverse Events (AE) | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Change in NT-proBNP | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Change in gamma-GTP | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Change in eGFR | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Change in MELD score (liver function) | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Change in SF-36 QoL scores | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Core Lab assessment of change in other pertinent echo | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
| Freedom from all-cause mortality at all study timepoints | 1Month, 6Month, 12Month, 2Years, 3Years, 4Years, and 5Years |
Other
| Measure | Time frame | Description |
|---|---|---|
| TR Grade Reduction | 12 months | Change in TR grade to moderate or less |
| KCCQ Reduction | 12 months | Average change in patients overall KCCQ summary scores by ≥ 10 |
Contacts
Primary ContactAngie Swenson
Outcome results
None listed