The VIRTUE Post Marketing Surveillance Registry (VIRTUE)

The VIRTUE Post Marketing Surveillance Registry - VALIANT Thoracic Stent Graft Evaluation For the Treatment of Descending Thoracic Aortic Dissections

The purpose of this post-market release registry is to collect additional information concerning safety, performance and health economic data with respect to the Medtronic VALIANT Thoracic Stent Graft with the Xcelerant Delivery System in the treatment of descending thoracic aortic dissections.

Study Overview

• Status: Completed
• Conditions: Aortic Dissection

Detailed Description

The patient device for use in this registry is the Medtronic VALIANT Thoracic Stent Graft System that received CE mark approval in March 2005.

The Medtronic VALIANT Thoracic Stent Graft with Xcelerant Delivery System is designed to treat diseases of the descending thoracic aorta including but not limited to aneurysms and dissections. The VALIANT Stent Graft is designed to exclude the aneurysm, the false lumen or site of rupture and restore the blood flow through the stent graft lumen. The device is intended for use either in patients who are candidates for conventional surgical repair, and in patients who are not candidates for conventional surgical repair due to pre-existing risk factors.

This registry is a prospective, non-randomized, single-arm, multi-center, European clinical registry with patients diagnosed with descending thoracic aortic dissection.

For this registry standard hospital procedures with respect to patient interventional care for thoracic aortic diseases will be followed.

This is a descriptive registry in which no specific hypotheses will be statistically tested.

• Study Type: Observational
• Enrollment (Actual): 100

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with a descending thoracic aortic dissection and who are amenable to stent-graft operation will be enrolled in the registry.

Description

Inclusion Criteria:

• Patient will be more than or equal to 18 years of age; or older if required by local regulations.
• Patient has an indication for treatment by either endovascular stent graft implantation for either an acute, sub-acute or chronic Type B dissection.
• Patient is amenable for stent-graft treatment (in accordance with the IFU).
• The patient is willing and able to cooperate with registry procedures and required follow-up visits.
• The patient or legal guardian has signed a patient informed consent form, including data privacy authorization (this criteria is not applicable for patients presenting in emergency with ruptured dissection and for whom legal representative is not available informed consent can be requested after surgical procedure).

Exclusion Criteria:

• Patients with a thoracic dissection for which optimal treatment is observation and medical management.
• Patient with current - non aortic - medical condition with a life expectancy less than one year.
• The patient is participating in another device or drug study (patient must have completed the follow-up phase of any previous study at least 30 days prior to enrolment in this registry).
• Time interval between medical indication for surgical intervention and endovascular procedure exceeds 4 months (122 days).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Descending thoracic aortic dissection; Patients diagnosed with a descending thoracic aortic dissection and who are amenable to stent-graft operation. The patient had an indication for treatment by either endovascular stent graft implantation for either an acute, sub-acute or chronic Type B dissection.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Disease-, Procedure- or Device-related Mortality at 12 Months Post-procedure	Disease, device or procedure-related mortality at 12 months post-procedure, defined as any death related to the device, to the disease or to the surgical procedure occurring in the period of 365 days following the day of the implant procedure.	12 months post-procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety	All causes mortality; Disease-, procedure- or device-related mortality	30 days or at discharge, 3/6/12/24/36 months
Efficacy/Performance	- Technical Success Technical success, defined as a composite of (i) successful introduction and deployment of at least one Valiant Thoracic Stent Graft at the intended location, (ii) successful coverage of the proximal entry tear, (iii) no immediate conversion to open surgery during the same intervention, (iv) absence of death within 24 hours post-procedure, and (v) the absence of significant graft twist, kink or obstruction by intra-operative measurements	30 days or at discharge, 3/6/12/24/36 months
Freedom of Re-intervention	Kaplan-Meier estimate of freedom from secondary procedures by clinical group.	30 days or at discharge, 3/6/12/24/36 months
Freedom From Disease-, Procedure- or Device-related Major Complications	Complications were assigned a severity score (according SVS scores) so that degrees of morbidity can be assessed and compared. A moderate complication indicates the need for significant intervention, prolongation of hospitalization more than 24 hours, and at most, minor permanent disability that does not preclude normal daily activity. A severe complication necessitates major surgical or medical intervention, may be associated with prolonged convalescence, is usually accompanied by prolonged or permanent disability, and may result in death. Both moderate and severe complications are considered as major complications. Kaplan-Meier estimate of freedom from disease-, procedure-, or device-related major complications by clinical group.	through 36 months
Freedom From Disease-, Procedure-, or Device-related Severe Complications	Complications were assigned a severity score (according SVS scores) so that degrees of morbidity can be assessed and compared. A severe complication necessitates major surgical or medical intervention, may be associated with prolonged convalescence, is usually accompanied by prolonged or permanent disability, and may result in death. Kaplan-Meier estimate of freedom from disease-, procedure-, or device-related severe complications	through 36 months
Clinical Success	Clinical success was defined as: (i) successful introduction and deployment of the Valiant Thoracic Stent Graft at the intended location; (ii) successful coverage of the proximal entry tear; (iii) no immediate conversion to open surgery;(iv) absence of surgical open repair or endovascular re-intervention; (v) absence of death related to aortic disease or treatment; (vi) absence of graft thrombosis, obstructions, twists or kinks; (vii) absence of graft migration;(viii) absence of graft integrity failure; (ix) at the level of the ostium of the LSA, the more proximal entry tear of the dissection, the largest section of the thoracic aorta, and at the first image/slice available with upper part of the liver: Absence of true lumen decrease in diameter (≥ 5 mm is significant) Absence of increase in total aortic diameter (≥ 5 mm is significant)	through 36 months

Collaborators and Investigators

• Sponsor: Medtronic Endovascular
• Investigators: Principal Investigator: M. Thompson, Prof., St George's Hospital; Principal Investigator: D. Gasparini, Dr., Azienda Ospedaliera "Santa Maria della Misericordia"; Principal Investigator: R. Fattori, Prof., Ospedale Sant'Orsola Malpighi; Principal Investigator: P. Cao, Dr., Unità di Chirurgia Vascolare, Ospedale R. Silvestrini; Principal Investigator: G. Garzón, Dr., Hospital Universitario La Paz; Principal Investigator: E. Ros, Prof., Hospital Clinico Universitario San Cecilio; Principal Investigator: B. Rylski, Dr., Universitätsklinikum Freiburg; Principal Investigator: S. Huptas, Dr., Universitätsklinikum Essen; Principal Investigator: I. Degrieck, Dr., Onze-Lieve-Vrouw Ziekenhuis; Principal Investigator: D. Dai-DoDo, Prof., Universitätsspital Bern, Inselspital; Principal Investigator: H. Roos, Dr., Sahlgrenska University Hospital, Sweden; Principal Investigator: R. Heijmen, Dr., St. Antonius Ziekenhuis; Principal Investigator: N. Cheshire, Prof., St Mary's NHS Trust; Principal Investigator: C. Nienaber, Dr, University School of Medicine Rostock

Publications and helpful links

General Publications

• Virtue Registry Investigators. The VIRTUE Registry of type B thoracic dissections--study design and early results. Eur J Vasc Endovasc Surg. 2011 Feb;41(2):159-66. doi: 10.1016/j.ejvs.2010.08.016. Epub 2010 Oct 16.

Study record dates

Study Major Dates

• Study Start: December 1, 2006
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: October 1, 2010
• First Submitted That Met QC Criteria: October 1, 2010
• First Posted (Estimate): October 4, 2010

Study Record Updates

• Last Update Posted (Estimate): December 11, 2013
• Last Update Submitted That Met QC Criteria: October 21, 2013
• Last Verified: October 1, 2013

More Information

Terms related to this study

• Keywords: stent; aortic; dissection; thoracic; Medtronic; Type B; Valiant; descending; VIRTUE
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Aneurysm; Aneurysm, Dissecting
• Other Study ID Numbers: MDTVIRTUE001