Medtronic CoreValve REDO Study (REDO)

Feasibility Study of Percutaneous Aortic Valve Implantation With the Medtronic CoreValve System for Percutaneous Aortic Valve Replacement (PAVR) in Patients With a Failing Previously Surgically Implanted Aortic Bioprosthesis and Presenting a High Risk for Repeat Surgical Valve Replacement

The proposed investigation is a prospective, multicenter, non-randomized study to evaluate the immediate benefits (at discharge and at 30 days) in terms of performance and safety of the implantation of the Medtronic CoreValve PAV in a failing aortic bioprosthesis. In addition, the study aims to evaluate the performance and the safety of the implantation of the Medtronic CoreValve PAV in a failing aortic bioprosthesis at subsequent annual follow-ups out to 48 months post procedure.

These objectives will be achieved through the following endpoints:

• Primary safety endpoint - Composite of Major Adverse Events
• Primary performance endpoint - Technical and procedural success at discharge

Patient Population: Eligible subjects will be at least 75 years old, presenting with a failing aortic bioprosthesis (stenotic, incompetent or mixed) including homograft or stented or stentless heterograft, considered poor surgical candidates and necessitating repeat aortic valve replacement. Up to 20 patients will be included in up to four hospitals.

Study Overview

• Status: Completed
• Conditions: Aortic Valve Stenosis
• Intervention / Treatment: Device: Medtronic CoreValve System

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Leipzig, Germany
    • Herzzentrum Leipzig GmbH
  • München, Germany
    • Deutsches Herzzentrum München
• Netherlands
  • Rotterdam, Netherlands
    • Erasmus MC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• > 74 years old,
• Symptomatic failing bioprosthetic aortic valve (stenotic, incompetent or mixed) confirmed by Doppler echocardiography,
• Logistic EuroSCORE > 15%, or

• Any of the following criteria:

  1. Left ventricular ejection fraction (LVEF) < 20%,
  2. Creatinine clearance < 20mL/min (estimation using the Cockcroft calculation),
  3. Renal failure requiring dialysis,
  4. Permanent and long lasting (> 6 month duration) atrial fibrillation,
  5. Cirrhosis of the liver (Child class A or B),
  6. Respiratory impairment (FEV1 < 1L),
  7. Previous cardiac surgery (i.e., CABG especially if patient had competent mammary arteries on left anterior descending (LAD) artery or occluded saphenous veins with high-risk of coronary embolism during re-operation),
  8. Pulmonary hypertension ³ 60mmHg,
  9. Recurrent pulmonary embolus,
  10. Moderate tricuspid (< grade 2+) insufficiency,
  11. Any severe disease contraindicating surgery,
  12. Calcified aorta (porcelain aorta),
  13. Recent myocardial infarction (less than 30 days at baseline),
  14. Contraindication for cardiopulmonary bypass,
• Inner diameter of the failing bioprosthetic aortic valve (homograft or stented or stentless heterograft) of ³ 19mm and < 26mm as determined by Doppler echocardiography,
• Signed informed consent form.

Exclusion Criteria:

• Known hypersensitivity or contraindication to aspirin, heparin, ticlopidine and clopidogrel, Nitinol, or sensitivity to contrast media which cannot be pre-medicated,
• Active infection or endocarditis,
• Any intra left ventricular mass, thrombus or vegetation evidenced by Doppler echocardiography,
• Mitral or tricuspid valvular insufficiency ³ grade 2+,
• Prosthetic mitral or tricuspid valve,
• Femoral and/or iliac and/or aortic vascular condition (stenosis, occlusion or tortuosity) that could complicate endovascular access to the aortic valve bioprosthesis,
• Symptomatic carotid or vertebral artery narrowing (> 70%) disease,
• Aortic abdominal or thoracic aneurysm,
• Bleeding diathesis or coagulopathy, or patient refuses blood transfusion,
• Active peptic ulcer or has had upper gastrointestinal bleeding within the past 3 months before baseline,
• Moribund status or cachexia with short life-expectancy independent of cardiac condition,
• Any acute neurological event or dysfunction occurred in the past 6 weeks before baseline or patient with severe senile dementia,
• Therapeutic invasive cardiac procedure, other than balloon aortic valvuloplasty, performed within 30 days prior to study procedure or to be performed during or within 30 days after the study procedure,
• Currently, enrolled in this study or another investigational drug or device study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CoreValve	Device: Medtronic CoreValve System; Transcatheter Aortic Valve; Other Names: Medtronic CoreValve Transcatheter aortic valve; Medtronic CoreValve Percutaneous aortic valve

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of MAE Free Subjects	Percentage of subjects without a composite major adverse event (MAE) at 30 days post procedure. the composite MAE includes: MACCE (Major Adverse Cardiac or Cerebral Event): cardiac death, documented Mobitz type II second degree and third degree atrioventricular block, neurological events and surgical aortic valve replacement.; MAE: non cardiac death including sudden unexpected or unexplained death, cardiac tamponade, nonstructural valve dysfunction resulting in stenosis or regurgitation at the study valve not intrinsic to the valve itself, structural valve deterioration cardiogenic shock, operated valve endocarditis, valve thrombosis, aortic dissection/perforation, major bleeding event, peripheral embolic event and emergent revascularization procedure.	30 days post-procedure
Technical Success.	The number of subjects in whom technical success was achieved where technical success was defined based on the device functionality as judged by the investigator adressing the ability of the system (1) to access the failing bioprosthetic valve via a peripheral vessel with the delivery catheter and (2) to deploy the valve accurately across the failing bioprosthetic valve and (3) to remove intact delivery system.	30 days post procedure

Collaborators and Investigators

• Sponsor: Medtronic Bakken Research Center
• Investigators: Principal Investigator: G. Schuler, Prof. Dr., Universitat Leipzig Herzzentrum, Germany; Principal Investigator: R. Lange, Prof. Dr., Deutsches Herzzentrum Munich, Germany; Principal Investigator: P. de Jaegere, Dr., Erasmus MC Rotterdam, Netherlands

Publications and helpful links

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): January 1, 2010
• Study Completion (Actual): January 1, 2011

Study Registration Dates

• First Submitted: January 15, 2010
• First Submitted That Met QC Criteria: January 15, 2010
• First Posted (Estimate): January 18, 2010

Study Record Updates

• Last Update Posted (Actual): January 31, 2019
• Last Update Submitted That Met QC Criteria: August 20, 2018
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Aortic Valve Disease; Heart Valve Diseases; Ventricular Outflow Obstruction; Aortic Valve Stenosis
• Other Study ID Numbers: COR-2007-03