Portico TAVI Implant With Transfemoral Delivery System

Assessment Of The St. Jude Medical Portico™ Transcatheter Aortic Valve Implant (TAVI) And The SJM TAVI Transfemoral Delivery System (Portico TF EU)

The purpose of this study is to assess the safety and effectiveness of the SJM Portico Transcatheter Heart Valve and the SJM TAVI Transfemoral Transcatheter delivery system in subjects with severe symptomatic aortic stenosis (AS).

Study Overview

• Status: Completed
• Conditions: Symptomatic Aortic Stenosis
• Intervention / Treatment: Device: Transcatheter Aortic Valve Implantation

Detailed Description

Data will be collected at baseline, procedure, discharge, 30 days post implant, 3 months post implant, 6 months post implant, and 12 months post implant.

• Study Type: Interventional
• Enrollment (Actual): 222
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • Adelaide, Australia
    • Adelaide Royal Hospital
• Denmark
  • Copenhagen, Denmark
    • Rigshospitalet Copenhagen
• Germany
  • Bad Nauheim, Germany
    • Kerckhoff Klinik
  • Bernau, Germany
    • Heart Center Bernau
  • Hamburg, Germany
    • Asklepios Klinik-St. Georg
  • Jena, Germany
    • Klinikum der Universität Jena
  • Karlsruhe, Germany
    • Klinik fur Herzhirurgie Karlruhe GmbH
  • Leipzig, Germany
    • Herzzentrum Leipzig
• Netherlands
  • Leeuwarden, Netherlands
    • Medical Center Leeuwarden
• United Kingdom
  • Leicester, United Kingdom
    • Glenfield Hospital
  • London, United Kingdom
    • St. Thomas' Hospital
  • London, United Kingdom
    • Kings College
  • Plymouth, United Kingdom
    • Derriford Hospital, Plymouth
  • Northern Ireland
    • Belfast, Northern Ireland, United Kingdom, BT12 6BA
      • Royal Victoria Hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Subject has given written study Informed Consent for participation prior to procedure.
2. Subject is ≥ 18 years of age or legal age in host country.
3. Subject's aortic annulus diameter meets the range indicated in the Instructions for use as measured by echocardiogram (echo) or CT conducted within the past 90 days.
4. Subject has senile degenerative aortic stenosis with echocardiography (echo) derived mean gradient >40mmHg or jet velocity greater than 4.0 m/s or an initial valve area of <1.0 cm2 (or aortic valve area index ≤ 0.6 cm2/m2). (Baseline measurement taken by echo within 30 days of procedure).
5. Subject has symptomatic aortic stenosis as demonstrated by NYHA Functional Classification of II or greater.
6. Subject is deemed high operable risk and suitable for TAVI per the medical opinion of the Subject Selection Committee (See Section 3.1 for the definition of the Subject Selection Committee)
7. Subject's predicted operative mortality or serious, irreversible morbidity risk is <50% at 30 days.
8. In the opinion of the Subject Selection Committee and based upon angiographic measurements, the subject has suitable peripheral vessels and aorta to allow for access of the 18 French delivery system.
9. Subject has structurally normal cardiac anatomy.
10. Subject is willing and able to comply with all required follow-up evaluations.

Exclusion Criteria:

1. Subject has a history of a cerebral vascular accident (CVA) or transient ischemic attack (TIA) within the past 6 months (≤180 days) of the index procedure.
2. Subject has carotid artery disease requiring intervention.
3. Subject has evidence of a myocardial infarction (MI) within the past 6 months (≤180 days) of the index procedure.
4. Subject has hypertrophic cardiomyopathy.
5. Subject has a native aortic valve that is congenitally unicuspid, bicuspid, quadricuspid or non-calcified as seen by echocardiography.
6. Subject has mitral or tricuspid valvular regurgitation (>grade III) or moderate to severe mitral stenosis.
7. Subject has aortic root angulation >70 degrees (horizontal aorta).
8. Subject has a pre-existing prosthetic valve or prosthetic ring in any position.
9. Subject refuses blood transfusion or surgical valve replacement.
10. Subject has left ventricular ejection fraction (LVEF) < 20%.
11. The subject has documented, untreated coronary artery disease (CAD) requiring revascularization.
12. Subject has severe basal septal hypertrophy.
13. Subject has had a percutaneous interventional or other invasive cardiac or peripheral procedure ≤ 14 days of the index procedure.
14. Subject has a history of or has active endocarditis.
15. Subject has echocardiographic evidence of intracardiac mass, thrombus, or vegetation.
16. Subject has hemodynamic instability (requiring inotropic support or mechanical heart assistance).
17. Subject is in acute pulmonary edema or requiring intravenous diuretic therapy to stabilize heart failure.
18. Subject with significant pulmonary disease.
19. Subject has significant chronic steroid use.
20. Subject has a known hypersensitivity or contraindication to anticoagulant or antiplatelet medication.
21. Subject has renal insufficiency as evidenced by a serum creatinine > 3.0 mg/dL (265µmol/L) or end-stage renal disease requiring chronic dialysis.
22. Subject has morbid obesity defined as BMI ≥ 40.
23. Subject's iliac arteries have severe calcification, tortuosity (>two 90 degree bends), diameter <6mm, or subject has had an aorto-femoral bypass.
24. Subject has ongoing infection or sepsis.
25. Subject has blood dyscrasias (leukopenia, acute anemia, thrombocytopenia, history of bleeding diathesis, or coagulopathy).
26. Subject has a current autoimmune disease that, in the opinion of the Principal Investigator precludes the subject from study participation.

27. Subject has significant aortic disease, including:

    • aortic abdominal aneurysm (AAA) ≥ 4cm
    • thoracic aneurysm (defined as a maximal luminal diameter of 5 cm or greater)
    • marked tortuosity
    • significant aortic arch atheroma or narrowing of the abdominal or thoracic aorta
    • severe tortuosity of the thoracic aorta.
28. Subject has a pre-existing endovascular stent graft in the supra- or infrarenal aorta or pre-existing stent grafts in the ileo-femoral arteries.
29. Subject has an active peptic ulcer or has had gastrointestinal (GI) bleeding within the past 90 days prior to the index procedure.
30. Subject is currently participating in another investigational drug or device study.
31. Subject requires emergency surgery for any reason.
32. Subject has a life expectancy < 12 months.
33. Subject has other medical, social or psychological conditions that, in the opinion of the Subject Selection Committee, preclude the subject from study participation.
34. Subject is suffering from dementia or admitted to a chronic care facility which would fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits.
35. Subject has a known allergy to contrast media, nitinol alloys, porcine tissue, or bovine tissue.

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: Transfemoral Access; Transfemoral Access for transcatheter aortic valve implant	Device: Transcatheter Aortic Valve Implantation; Placement of the SJM Portico aortic valve with a transfemoral delivery system

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All Cause Mortality	Number of participants that reported all cause mortality	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Select Cardiovascular Adverse Events	Number of participants with select cardiovascular adverse events	30 days
Participant NYHA Classification at Day 30	The New York Heart Association (NYHA) functional classification system relates symptoms to everyday activities and the patient's quality of life. Class I. Patients with cardiac disease but without resulting limitation of physical activity. Class II. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Class III. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Class IV. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown & Co; 1994:253-256.	day 30
Number of Participants With Acute Device Success	Successful vascular access, delivery and deployment of the device and successful retrieval of the delivery system; Correct position of the device in the proper anatomical location; Intended performance of the prosthetic heart valve (Aortic Valve Area >1.2 cm2 and mean aortic valve gradient <20 mmHg or peak velocity <3 m/s, without moderate or severe prosthetic valve AR); Only one valve implanted in the proper anatomical location	7 days

Collaborators and Investigators

• Sponsor: Abbott Medical Devices
• Investigators: Principal Investigator: Ganesh Manoharan, MD, Royal Victoria Hospital

Publications and helpful links

General Publications

• Walther T, Manoharan G, Linke A, Mollmann H, Holzhey D, Worthley SG, Kim WK, Schafer U. Incidence of new-onset left bundle branch block and predictors of new permanent pacemaker following transcatheter aortic valve replacement with the Portico valve. Eur J Cardiothorac Surg. 2018 Sep 1;54(3):467-474. doi: 10.1093/ejcts/ezy078.
• Linke A, Holzhey D, Mollmann H, Manoharan G, Schafer U, Frerker C, Worthley SG, van Boven AJ, Redwood S, Kovac J, Butter C, Sondergaard L, Lauten A, Schymik G, Walther T. Treatment of Aortic Stenosis With a Self-Expanding, Resheathable Transcatheter Valve: One-Year Results of the International Multicenter Portico Transcatheter Aortic Valve Implantation System Study. Circ Cardiovasc Interv. 2018 Feb;11(2):e005206. doi: 10.1161/CIRCINTERVENTIONS.117.005206.

Study record dates

Study Major Dates

• Study Start: December 1, 2011
• Primary Completion (Actual): October 1, 2015
• Study Completion (Actual): September 1, 2016

Study Registration Dates

• First Submitted: December 5, 2011
• First Submitted That Met QC Criteria: December 13, 2011
• First Posted (Estimate): December 15, 2011

Study Record Updates

• Last Update Posted (Actual): February 4, 2019
• Last Update Submitted That Met QC Criteria: January 31, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: aortic valve replacement; aortic stenosis; transcatheter aortic valve implantation; TAVI; aortic valve stenosis; valvular heart disease
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Pathological Conditions, Anatomical; Aortic Valve Disease; Heart Valve Diseases; Ventricular Outflow Obstruction; Aortic Valve Stenosis; Constriction, Pathologic
• Other Study ID Numbers: 1105

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO