The Medtronic CoreValve™ Evolut R™ CE Mark Clinical Study

To assess the safety and clinical performance of the CoreValve™ Evolut R™ System.

Study Overview

• Status: Completed
• Conditions: Aortic Stenosis
• Intervention / Treatment: Device: The CoreValve™ Evolut R TAV™ system

Detailed Description

The study objectives are to assess the safety and clinical performance of the CoreValve™ Evolut R™ System in patients with severe symptomatic aortic stenosis who are considered at high through extreme risk for surgical aortic valve replacement. These objectives will be accomplished by a prospective clinical study involving up to 60 implanted subjects among up to six study centers.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • Victoria
    • Melbourne, Victoria, Australia, 3004
      • Epworth Hospital
    • Melbourne, Victoria, Australia
      • Monash Medical Center
• New Zealand
  • Hamilton, New Zealand
    • Waikato Hospital
• United Kingdom
  • Belfast, United Kingdom, BT12 6BA
    • Royal Victoria Hospital
  • Leeds, United Kingdom, LS1 3EX
    • Leeds General Infirmary
  • London, United Kingdom
    • St. George's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Severe aortic stenosis, defined as aortic valve area of < 1.0 cm2 (or aortic valve area index of < 0.6 cm2/m2) by the continuity equation, AND mean gradient > 40 mmHg or maximal aortic valve velocity > 4.0 m/sec by resting echocardiogram.
2. Estimated 30 day mortality risk of > 15% by study center Heart Team assessment,33 OR at least two cardiovascular surgeons from the study center deny surgery because of prohibitive operative risk, estimated to be a combined >50% risk of irreversible mortality or morbidity.
3. Symptoms of aortic stenosis, and NYHA Functional Class II or greater.
4. The subject meets the legal minimum age to provide informed consent based on local regulatory requirements, and has provided written informed consent as approved by the EC/IRB of the respective clinical site.

5. The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.

   Exclusion Criteria:

   Clinical exclusion criteria:

6. Subject has been offered SAVR but has declined.
7. Any condition considered a contraindication for placement of a bioprosthetic valve (e.g. subject is indicated for mechanical prosthetic valve).
8. Known hypersensitivity or contraindication to Nitinol.
9. Blood dyscrasias as defined: leukopenia (WBC <1000 mm3), thrombocytopenia (platelet count <50,000 cells/mm3), history of bleeding diathesis or coagulopathy, or hypercoagulable states.
10. Untreated clinically significant coronary artery disease requiring revascularization.
11. Severe left ventricular dysfunction with left ventricular ejection fraction (LVEF) <20% by echocardiography, contrast ventriculography, or radionuclide ventriculography.
12. End stage renal disease requiring chronic dialysis of creatinine clearance < 20 cc/min.
13. Ongoing sepsis, including active endocarditis.
14. Any condition considered a contraindication to extracorporeal assistance.
15. Any percutaneous coronary or peripheral interventional procedure with a bare metal stent performed within 30 days prior to Heart Team assessment, or within six months prior to Heart Team assessment for procedures with a drug eluting stents.
16. Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within eight weeks of Heart Team Assessment .
17. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or mechanical hemodynamic support.
18. Recent (within 6 months of Heart Team assessment) cerebrovascular accident (CVA) or transient ischemic attack (TIA).
19. Gastrointestinal (GI) bleeding that would preclude anticoagulation.
20. Subject refuses a blood transfusion.
21. Severe dementia (resulting in either inability to provide informed consent for the study/procedure, prevents independent lifestyle outside of a chronic care facility, or will fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits).
22. Estimated life expectancy of less than 12 months due to associated non-cardiac co-morbid conditions.
23. Other medical, social, or psychological conditions that in the opinion of the Investigator precludes the subject from appropriate consent or adherence to the protocol required follow-ups exams.
24. Currently participating in an investigational drug or another device study (excluding registries).
25. Evidence of an acute myocardial infarction ≤30 days before the index procedure.
26. Need for emergency surgery for any reason.
27. Liver failure (Child-C).

28. Subject is pregnant or breast feeding.

    Anatomical exclusion criteria:

29. Pre-existing prosthetic heart valve in any position.
30. Mixed aortic valve disease (aortic stenosis with moderate or severe aortic regurgitation).
31. Severe mitral regurgitation.
32. Severe tricuspid regurgitation.
33. Moderate or severe mitral stenosis.
34. Hypertrophic obstructive cardiomyopathy.
35. Echocardiographic or Multi-Slice Computed Tomography (MSCT) evidence of intracardiac mass thrombus or vegetation.
36. Congenital bicuspid or unicuspid valve verified by echocardiography.

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: The CoreValve™ Evolut R TAV™ system; CoreValve™ Evolut R™ System which consists of the Evolut R™ Transcatheter Aortic Valve (26 & 29 mm sizes), EnVeo R™ Delivery Catheter System with Enveo InLine™ Sheath, and EnVeo R™ Loading System	Device: The CoreValve™ Evolut R TAV™ system; CoreValve™ Evolut R™ System which consists of the Evolut R™ Transcatheter Aortic Valve (26 & 29 mm sizes), EnVeo R™ Delivery Catheter System with Enveo InLine™ Sheath, and EnVeo R™ Loading System; Other Names: CoreValve™ EvolutR™ Transcatheter Ao Valve; EnveoR™ Delivery Catheter System w/ Enveo InLine™ Sheath; EnVeoR™ Loding System

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause Mortality Rate at 30 Days	The All-cause mortality rate at 30 days per the VARC II recommendation of clinical endpoints for TAVI. More specifically: Cardiovascular mortality (Any of the following criteria); Death due to proximate cardiac cause (e.g. myocardial infarction, cardiac tamponade, worsening heart failure); Death caused by non-coronary vascular conditions such as neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular disease; All procedure-related deaths, including those related to a complication of the procedure or treatment for a complication of the procedure; All valve-related deaths including structural or non-structural valve dysfunction or other valve-related adverse events; Sudden or unwitnessed death; Death of unknown cause Non-cardiovascular mortality; Any death in which the primary cause of death is clearly related to another condition (e.g. trauma, cancer, suicide)	30 days
Stroke Rate (Disabling and Non-disabling) at 30 Days	The Stroke rate (disabling and non-disabling) at 30 days per the VARC II definitions. Stroke is defined as an acute episode of focal or global neurological dysfunction caused by the brain, spinal cord, or retinal vascular injury as a result of haemorrhage or infarction. Stroke may be classified as ischaemic or haemorrhagic with appropriate subdefinitions. Ischaemic stroke is defined as an acute episode of focal cerebral, spinal, or retinal dysfunction caused by infarction of central nervous system tissue. Haemorrhagic stroke is defined as an acute episode of focal or global cerebral or spinal dysfunction caused by intraparenchymal, intraventricular, or subarachnoid haemorrhage. A stroke may be classified as 'undetermined' if there is insufficient information to allow the categorization as ischaemic or haemorrhagic.	30 days
Device Success Rate at 24 Hours to Seven Days	Device success rate at 24 hours to seven days, defined as:Absence of procedural mortality, ANDCorrect positioning of a single prosthetic heart valve into the proper anatomical location, ANDIntended performance of the prosthetic heart valve, defined as the absence of patient-prosthesis-mismatch and mean aortic valve gradient less than 20 mmHg (or peak velocity < 3 m/sec), AND absence of moderate or severe prosthetic valve regurgitation.; The percentage of subjects with no more than mild aortic regurgitation at early post procedure echocardiogram (24 hours through seven days).	24 hours to seven days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VARC II Combined Safety Endpoint at 30 Days	The VARC II Combined Safety Endpoint at 30 days includes the following components: All-Cause Mortality, All Stroke, Life Threatening or Disabling Bleeding, Acute Kidney Injury: Stage 2 or 3, Coronary Artery Obstruction, Major Vascular Complication, and Valve-Related Dysfunction Requiring Repeat Procedure.	30 days
Event Rates of the Individual Components of the VARC II Composite Safety Endpoint at 30 Days	The Individual components of the VARC II composite safety endpoint at 30 days per the Kaplan Meier Event Rate (%).	30 days
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Mean Gradient	The hemodynamic performance will be measured by the Mean Prosthetic Valve Gradient for 59 subjects, measured with the Doppler echocardiography.	30 days
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - • Effective Orifice Area (EOA)	Effective orifice area	30 days
Hemodynamic Performance Metrics at 30 Days by Doppler Echocardiography - Total Aortic Regurgitation (Transvalvular & Paravalvular)	Degree of Total prosthetic valve regurgitation (transvalvular & paravalvular)	30 days
Resheath or Recapture Success Rate (When Attempted), Where Successful Recapture is Defined as Evolut R™ TAV (Including the Frame) is Fully Resheathed Into the Capsule of the Delivery Catheter, as Verified by Fluoroscopy.	Resheath or Recapture success rate (when attempted), where successful recapture is defined as Evolut R™ TAV (including the frame) is fully resheathed into the capsule of the delivery catheter, as verified by fluoroscopy. Resheathing or recapturing of the TAV was attempted on 15 subjects.	Day 1

Collaborators and Investigators

• Sponsor: Medtronic Cardiovascular
• Collaborators: Medtronic
• Investigators: Study Director: Eric Vang, PhD, Director Clinical Research Structural Heart

Publications and helpful links

General Publications

• Manoharan G, Walton AS, Brecker SJ, Pasupati S, Blackman DJ, Qiao H, Meredith IT. Treatment of Symptomatic Severe Aortic Stenosis With a Novel Resheathable Supra-Annular Self-Expanding Transcatheter Aortic Valve System. JACC Cardiovasc Interv. 2015 Aug 24;8(10):1359-1367. doi: 10.1016/j.jcin.2015.05.015.

Study record dates

Study Major Dates

• Study Start: October 1, 2013
• Primary Completion (Actual): August 1, 2014
• Study Completion (Actual): October 1, 2016

Study Registration Dates

• First Submitted: June 5, 2013
• First Submitted That Met QC Criteria: June 11, 2013
• First Posted (Estimate): June 12, 2013

Study Record Updates

• Last Update Posted (Actual): August 22, 2018
• Last Update Submitted That Met QC Criteria: August 21, 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: MDT10093773DOC

Plan for Individual participant data (IPD)

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