Portico Re-sheathable Transcatheter Aortic Valve System US IDE Trial (PORTICO-IDE)

The objective of the PORTICO pivotal IDE trial is to evaluate the safety and effectiveness of the St Jude Medical (SJM) Portico Transcatheter Heart Valve and Delivery Systems (Portico) in the treatment of severe symptomatic aortic stenosis via transfemoral and alternative delivery methods in high risk and extreme risk patients.

Study Overview

• Status: Recruiting
• Conditions: Aortic Valve Stenosis
• Intervention / Treatment: Device: Portico transcatheter aortic valve; Device: Commercially available transcatheter aortic valve

Detailed Description

The PORTICO pivotal IDE trial will include a randomized cohort of 750 subjects enrolled at up to 70 investigational sites in the United States and Australia. Patients will be randomized (1:1) to receive the SJM Portico Transcatheter Heart Valve and Delivery Systems (Portico) or any FDA-approved, commercially-available Transcatheter Aortic Valve Replacement (TAVR) System. The randomized cohort will be tested for two co-primary endpoints at 30 days (primary safety endpoint) and 1 year (primary effectiveness endpoint). At the time of the primary randomized cohort analysis, the risk cohorts will be combined and analysis will be conducted on the intention-to-treat (n=750) population.

The FlexNav Delivery System study will be conducted as a separate arm of the PORTICO IDE trial and will include up to 200 high or extreme risk subjects; including a minimum of 100 analysis subjects. The study will characterize the safety of the next-generation Portico Delivery System ("FlexNav™ Delivery System"). The primary analysis cohort will include FlexNav analysis subjects.

The IDE Valve-in-Valve registry will enroll up to 100 high or extreme risk subjects with a failed surgical bioprosthesis who are eligible to receive a Portico Transcatheter Heart Valve.

All subjects enrolled in the PORTICO pivotal IDE trial will undergo follow-up at baseline, peri- and post-procedure, at discharge or 7 days post-procedure (whichever comes first), 30 days, 6 months, 12-months and then annually through 5-years.

• Study Type: Interventional
• Enrollment (Estimated): 1150
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Kimberly S Behning; Phone Number: 651-756-5622; Email: kimberly.behning@abbott.com

Study Locations

• Australia
  • New South Wales
    • Sydney, New South Wales, Australia, 2109
      • Completed
      • Macquarie University Hospital
  • Queensland
    • Chermside, Queensland, Australia, 4032
      • Completed
      • The Prince Charles Hospital
  • South Australia
    • Adelaide, South Australia, Australia, 5000
      • Recruiting
      • Royal Adelaide Hospital
      • Principal Investigator: Joseph Montarello, MD
  • Victoria
    • Melbourne, Victoria, Australia, 3004
      • Recruiting
      • The Alfred Hospital
      • Principal Investigator: Tony Walton, M.D.
  • Western Australia
    • Murdoch, Western Australia, Australia, 6150
      • Recruiting
      • Fiona Stanley Hospital
      • Principal Investigator: Gerald Yong, M.D.
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35249
      • Active, not recruiting
      • University Hospital - Univ. of Alabama at Birmingham (UAB)
  • Arizona
    • Phoenix, Arizona, United States, 85006
      • Active, not recruiting
      • Banner - University Medical Center Phoenix
  • California
    • Concord, California, United States, 94520
      • Active, not recruiting
      • John Muir Medical Center
    • La Jolla, California, United States, 92037
      • Completed
      • Scripps Green Hospital
    • Los Angeles, California, United States, 90048
      • Recruiting
      • Cedars-Sinai Medical Center
      • Principal Investigator: Raj Makkar, M.D.
    • Los Angeles, California, United States, 90033
      • Active, not recruiting
      • USC University Hospital
    • Newport Beach, California, United States, 92663
      • Completed
      • HOAG Memorial Hospital Presbyterian
    • Palo Alto, California, United States, 94305
      • Active, not recruiting
      • Stanford University Medical Center
    • Pasadena, California, United States, 91109
      • Completed
      • Huntington Memorial Hospital
    • Sacramento, California, United States, 95819
      • Active, not recruiting
      • Mercy General Hospital
    • Sacramento, California, United States, 95816
      • Completed
      • Sutter Memorial Hospital
    • Thousand Oaks, California, United States, 91360
      • Active, not recruiting
      • Los Robles Regional Medical Center
  • District of Columbia
    • Washington, District of Columbia, United States, 20010
      • Recruiting
      • Washington Hospital Center
      • Principal Investigator: Ron Waksman, M.D.
  • Florida
    • Atlantis, Florida, United States, 33462
      • Completed
      • JFK Medical Center
    • Clearwater, Florida, United States, 33756
      • Active, not recruiting
      • Morton Plant Valve Clinic
    • Delray Beach, Florida, United States, 33484
      • Completed
      • Delray Medical Center
    • Orlando, Florida, United States, 32803
      • Completed
      • Florida Hospital Orlando
  • Georgia
    • Atlanta, Georgia, United States, 30308
      • Recruiting
      • Emory University Hospital
      • Principal Investigator: Chandan Devireddy, M.D.
  • Illinois
    • Oak Lawn, Illinois, United States, 60653
      • Recruiting
      • Advocate Christ Medical Center
      • Principal Investigator: Ravi Ramana, M.D.
      • Principal Investigator: Antone Tatooles, M.D.
  • Indiana
    • Indianapolis, Indiana, United States, 46290
      • Recruiting
      • St. Vincent Hospital
      • Principal Investigator: James Hermiller, M.D.
      • Principal Investigator: David Heimansohn, M.D.
  • Iowa
    • West Des Moines, Iowa, United States, 50266
      • Active, not recruiting
      • Iowa Heart Center
  • Kansas
    • Wichita, Kansas, United States, 67226
      • Recruiting
      • Cardiovascular Research Institute of Kansas
      • Principal Investigator: Bassem Chehab, M.D.
  • Louisiana
    • New Orleans, Louisiana, United States, 70121
      • Active, not recruiting
      • Ochsner Medical Center
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Active, not recruiting
      • Massachusetts General Hospital
  • Michigan
    • Lansing, Michigan, United States, 48912
      • Recruiting
      • Sparrow Clinical Research Institute
      • Principal Investigator: Nam Cho, M.D.
  • Minnesota
    • Minneapolis, Minnesota, United States, 55407
      • Completed
      • Abbott Northwestern Hospital
    • Rochester, Minnesota, United States, 55905
      • Completed
      • Mayo Clinic
  • Mississippi
    • Tupelo, Mississippi, United States, 38801
      • Completed
      • North Mississippi Medical Center
  • Missouri
    • Kansas City, Missouri, United States, 64111
      • Completed
      • St. Luke's Hospital
    • Saint Louis, Missouri, United States, 63110
      • Completed
      • Barnes-Jewish Hospital
    • Springfield, Missouri, United States, 65804
      • Active, not recruiting
      • Mercy Hospital Springfield
  • New Hampshire
    • Manchester, New Hampshire, United States, 03102
      • Active, not recruiting
      • Catholic Medical Center
  • New Jersey
    • Hackensack, New Jersey, United States, 07601
      • Completed
      • Hackensack University Medical Center
    • Newark, New Jersey, United States, 07112
      • Active, not recruiting
      • Newark Beth Israel Medical Center
  • New York
    • Albany, New York, United States, 12208
      • Recruiting
      • Albany Medical Center
      • Principal Investigator: Sanjay Samy, MD
    • Brooklyn, New York, United States, 11219
      • Active, not recruiting
      • Maimonides Medical Center
    • Mineola, New York, United States, 11501
      • Recruiting
      • Winthrop University Hospital
      • Principal Investigator: Richard Schwartz, D.O.
    • New York, New York, United States, 10021
      • Active, not recruiting
      • New York Presbyterian Hospital / Cornell University
    • New York, New York, United States, 10075
      • Completed
      • Lenox Hill Hospital
    • Roslyn, New York, United States, 11576
      • Active, not recruiting
      • St. Francis Hospital
  • North Carolina
    • Asheville, North Carolina, United States, 28803
      • Recruiting
      • Mission Health and Hospitals
      • Principal Investigator: Mark Groh, M.D.
    • Chapel Hill, North Carolina, United States, 27599
      • Active, not recruiting
      • University of North Carolina at Chapel Hill
    • Durham, North Carolina, United States, 27710
      • Active, not recruiting
      • Duke University Medical Center
    • Greenville, North Carolina, United States, 27834
      • Completed
      • East Carolina Heart Institute
  • Ohio
    • Cleveland, Ohio, United States, 44195
      • Active, not recruiting
      • The Cleveland Clinic Foundation
    • Columbus, Ohio, United States, 43210
      • Recruiting
      • Ohio State University
      • Principal Investigator: Scott Lilly, M.D.
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73120
      • Active, not recruiting
      • Oklahoma Heart Hospital
  • Pennsylvania
    • Harrisburg, Pennsylvania, United States, 17105
      • Active, not recruiting
      • Pinnacle Health System
    • Hershey, Pennsylvania, United States, 17033
      • Active, not recruiting
      • Penn State Milton S. Hershey Medical Center
    • Philadelphia, Pennsylvania, United States, 19104
      • Active, not recruiting
      • Hospital of the University of Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15212
      • Active, not recruiting
      • Allegheny Singer Research Institute
    • Pittsburgh, Pennsylvania, United States, 15213
      • Completed
      • University of Pittsburgh Medical Center
    • Wynnewood, Pennsylvania, United States, 19096
      • Active, not recruiting
      • Main Line Health Center/Lankenau Hospital
  • South Dakota
    • Sioux Falls, South Dakota, United States, 57117
      • Active, not recruiting
      • Sanford USD Medical Center
  • Tennessee
    • Memphis, Tennessee, United States, 38120
      • Recruiting
      • Baptist Memorial Hospital
      • Principal Investigator: Basil Paulus, M.D.
    • Nashville, Tennessee, United States, 37203
      • Recruiting
      • Centennial Medical Center
      • Principal Investigator: Seenu Reddy, M.D.
      • Principal Investigator: John Riddick, M.D.
  • Texas
    • Austin, Texas, United States, 78756
      • Active, not recruiting
      • Heart Hospital of Austin
    • Houston, Texas, United States, 77030
      • Recruiting
      • CHI St. Luke's Health Baylor College of Medicine Medical Center
      • Principal Investigator: Joseph Coselli, M.D.
      • Principal Investigator: Guilherme Silva, M.D.
    • Houston, Texas, United States, 77030
      • Active, not recruiting
      • Memorial Hermann Hospital
    • Houston, Texas, United States, 77030
      • Completed
      • The Methodist Hospital
    • Plano, Texas, United States, 75093
      • Recruiting
      • The Heart Hospital Baylor Plano
      • Principal Investigator: William Brinkman, M.D.
      • Principal Investigator: Molly Szerlip, MD
  • Utah
    • Salt Lake City, Utah, United States, 84132
      • Completed
      • University of Utah Hospital
  • Virginia
    • Falls Church, Virginia, United States, 22042
      • Active, not recruiting
      • Inova Fairfax Hospital
    • Norfolk, Virginia, United States, 23507
      • Recruiting
      • Sentara Norfolk General Hospital
      • Principal Investigator: Clinton Kemp, M.D.
  • Washington
    • Seattle, Washington, United States, 98107
      • Completed
      • Swedish Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

1. Subjects must have co-morbidities such that the surgeon and cardiologist Co-Investigators concur that the predicted risk of operative mortality is ≥15% or a minimum Society of Thoracic Surgeons (STS) score of 8%. A candidate who does not meet the STS score criteria of ≥ 8% can be included in the study if a peer review by at least two surgeons concludes and documents that the patient's predicted risk of operative mortality is ≥15%. The surgeon's assessment of operative comorbidities not captured by the STS score must be documented in the study case report form as well as in the patient medical record.
2. Subject is 21 years of age or older at the time of consent.
3. Subject has senile degenerative aortic valve stenosis with echocardiographically derived criteria: mean gradient >40 mmHg or jet velocity greater than 4.0 m/s or Doppler Velocity Index <0.25 and an initial aortic valve area (AVA) of ≤ 1.0 cm2 (indexed effective orifice area (EOA) ≤ 0.6 cm2/m2). (Qualifying AVA baseline measurement must be within 60 days prior to informed consent).
4. Subject has symptomatic aortic stenosis as demonstrated by New York Heart Association (NYHA) Functional Classification of II, III, or IV.
5. The subject has been informed of the nature of the study, agrees to its provisions and has provided written informed consent as approved by the Institutional Review Board (IRB) of the respective clinical site.
6. The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.

7. Subject's aortic annulus is 19-27mm diameter as measured by computerized tomography (CT) conducted within 12 months prior to informed consent. Note: if CT is contraindicated and/or not possible to be obtained for certain subjects, a 3D echo and non-contrast CT of chest and abdomen/pelvis may be accepted if approved by the subject selection committee.

   For a subject to be considered an Extreme Risk candidate they must meet # 2, 3, 4, 5, 6, 7 of the above criteria, and

8. The subject, after formal consults by a cardiologist and two cardiovascular surgeons agree that medical factors preclude operation, based on a conclusion that the probability of death or serious, irreversible morbidity exceeds the probability of meaningful improvement. Specifically, the probability of death or serious, irreversible morbidity should exceed 50%. The surgeons' consult notes shall specify the medical or anatomic factors leading to that conclusion and include a printout of the calculation of the STS score to additionally identify the risks in these patients.

Exclusion Criteria

1. Evidence of an acute myocardial infarction (defined as: ST Segment Elevation as evidenced on 12 Lead ECG) within 30 days prior to index procedure.
2. Aortic valve is a congenital unicuspid or congenital bicuspid valve or is non-calcified as verified by echocardiography.
3. Mixed aortic valve disease (aortic stenosis and aortic regurgitation with predominant aortic regurgitation 3-4+).
4. Any percutaneous coronary or peripheral interventional procedure performed within 30 days prior to index procedure.
5. Pre-existing prosthetic heart valve or other implant in any valve position, prosthetic ring, severe circumferential mitral annular calcification (MAC) which is continuous with calcium in the left ventricular outflow tract (LVOT), severe (greater than 3+) mitral insufficiency, or severe mitral stenosis with pulmonary compromise. Subjects with pre-existing surgical bioprosthetic aortic heart valve should be considered for the Valve-in-Valve registry.
6. Blood dyscrasias as defined: leukopenia (WBC<3000 mm3), acute anemia (Hb < 9 g/dL), thrombocytopenia (platelet count <50,000 cells/mm³).
7. History of bleeding diathesis or coagulopathy.
8. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or mechanical hemodynamic support.
9. Untreated clinically significant coronary artery disease requiring revascularization.
10. Hemodynamic instability requiring inotropic support or mechanical heart assistance.
11. Need for emergency surgery for any reason.
12. Hypertrophic cardiomyopathy with or without obstruction (HOCM).
13. Severe ventricular dysfunction with left ventricular ejection fraction (LVEF) <20% as measured by resting echocardiogram.
14. Echocardiographic evidence of intracardiac mass, thrombus or vegetation.
15. Active peptic ulcer or upper gastrointestinal (GI) bleeding within 3 months prior to index procedure.
16. A known hypersensitivity or contraindication to aspirin, heparin, ticlopidine (Ticlid), or clopidogrel (Plavix), or sensitivity to contrast media which cannot be adequately premedicated.
17. Recent (within 6 months prior to index procedure date) cerebrovascular accident (CVA) or a transient ischemic attack (TIA).
18. Renal insufficiency (creatinine > 3.0 mg/dL) and/or end stage renal disease requiring chronic dialysis.
19. Life expectancy < 12 months from the time of informed consent due to non-cardiac co-morbid conditions.
20. Significant aortic disease, including abdominal aortic or thoracic aneurysm defined as maximal luminal diameter 5cm or greater; marked tortuosity (hyperacute bend), aortic arch atheroma (especially if thick [> 5 mm], protruding or ulcerated) or narrowing (especially with calcification and surface irregularities) of the abdominal or thoracic aorta, severe "unfolding" and tortuosity of the thoracic aorta (applicable for transfemoral patients only).
21. Native aortic annulus size < 19 mm or > 27 mm per the baseline diagnostic imaging.
22. Aortic root angulation > 70° (applicable for transfemoral patients only).
23. Currently participating in an investigational drug or device study.
24. Active bacterial endocarditis within 6 months prior to the index procedure.
25. Bulky calcified aortic valve leaflets in close proximity to coronary ostia.
26. Non-calcified aortic annulus
27. Iliofemoral vessel characteristics that would preclude safe placement of the introducer sheath such as severe obstructive calcification, or severe tortuosity (applicable for transfemoral patients only).

Additional Exclusion Criteria (Transcatheter Access Related)

For selection of an appropriate alternative access delivery method, subjects were screened using the following access specific exclusion criteria:

Transaortic (TAo) Subject Cohort Specific Exclusion Criteria

1. Subject has pre-existing patent RIMA graft that would preclude access.
2. Subject has a hostile chest or other condition that complicates transaortic access.
3. Subject has a porcelain aorta, defined as an extensive circumferential calcification of the ascending aorta that would complicate TAo access.

Additional exclusion criteria for transaortic access using the FlexNav™ Delivery System:

1. Subject has a distance between the annular plane and the aortic access site <7 cm (2.8")
2. Subject has a distance between the annular plane and the separate introducer sheath distal tip <6 cm (2.4")

Subclavian/Axillary Subject Cohort Specific Exclusion Criteria

1. Subject's access vessel (subclavian/axillary) diameter will not allow for introduction of the applicable 18 Fr or 19 Fr delivery system.
2. Subject's subclavian/axillary arteries have severe calcification and/or tortuosity.

3. Subject's aortic root angulation is:

   • Left Subclavian/Left Axillary: >70◦
   • Right Subclavian/Right Axillary: >30◦
4. Subject has a history of patent LIMA/RIMA graft that would preclude access

Additional exclusion criteria for subclavian/axillary access using the FlexNav™ Delivery System:

1. Subject's access vessel (subclavian/axillary) has a distance between the annular plane and the integrated sheath distal tip <17 cm (6.7")
2. Subject's access vessel requires the delivery system to be advanced through a separate introducer sheath

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Randomized IDE Cohort, Portico Valve; Portico transcatheter aortic valve and Portico delivery system. Status: ACTIVE, NOT ENROLLING.	Device: Portico transcatheter aortic valve; St. Jude Medical transcatheter Portico aortic valve
Active Comparator: Randomized IDE Cohort, CAV; Any FDA approved, commercially-available transcatheter aortic valve (CAV). Status: ACTIVE, NOT ENROLLING.	Device: Commercially available transcatheter aortic valve; Commercially available transcatheter aortic valve
Experimental: Nested Valve-in-Valve Registry; Subjects who have documented failed aortic surgical valve prosthesis and are deemed eligible to receive a transcatheter Portico valve Status: ACTIVE, ENROLLING.	Device: Portico transcatheter aortic valve; St. Jude Medical transcatheter Portico aortic valve
Experimental: FlexNav Delivery System Study; Portico transcatheter aortic valve and FlexNav delivery system Status: ACTIVE, NOT ENROLLING	Device: Portico transcatheter aortic valve; St. Jude Medical transcatheter Portico aortic valve

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Effectiveness Endpoint (Randomized IDE Cohort)	A composite of all-cause mortality or disabling stroke at one year.	One-year from randomization
Primary Safety Endpoint (Randomized IDE Cohort)	Non-hierarchical composite of all-cause mortality, disabling stroke, life threatening bleeding requiring blood transfusion, acute kidney injury requiring dialysis, or major vascular complications at 30 days.	30 days from randomization
Percentage of Patients With Major Vascular Complications (Primary Safety Endpoint- FlexNav Delivery System Study)	Valve Academic Research Consortium (VARC) 2- defined major vascular complications	30 days from index procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Patients With Severe Aortic Regurgitation (Randomized IDE Cohort)	Severe aortic regurgitation (AR) at one year	One year
Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score (Randomized IDE Cohort)	Kansas City Cardiomyopathy Questionnaire (KCCQ) at one year. Scale 0 to 100; with higher scores indicating better symptoms and physical functioning	One year
Percentage of Patients With Moderate or Severe Aortic Regurgitation (Randomized IDE Cohort)	Moderate or severe aortic regurgitation at one year	One year
Six-Minute Walk Test- Total Distance Walked (Randomized IDE Cohort)	Six-minute walk distance at one year	One year
Percentage of Patients With Composite Safety Endpoint (Nested Valve-in-Valve Registry)	Non-hierarchical composite of all-cause mortality, disabling stroke, life threatening bleeding requiring blood transfusion, acute kidney injury requiring dialysis, or major vascular complications at 30 days from index procedure. Anticipated completion date (2022)	30 days from index procedure
Percentage of Patients With All-cause Mortality or Disabling Stroke (Nested Valve-in-Valve Registry)	A composite of all-cause mortality or disabling stroke at one year Anticipated completion data (2023)	One year from index procedure

Collaborators and Investigators

• Sponsor: Abbott Medical Devices
• Investigators: Principal Investigator: Raj R Makkar, MD, Cedars-Sinai Medical Center; Principal Investigator: Gregory P Fontana, MD, Los Robles Regional Medical Center

Publications and helpful links

General Publications

• Makkar RR, Cheng W, Waksman R, Satler LF, Chakravarty T, Groh M, Abernethy W, Russo MJ, Heimansohn D, Hermiller J, Worthley S, Chehab B, Cunningham M, Matthews R, Ramana RK, Yong G, Ruiz CE, Chen C, Asch FM, Nakamura M, Jilaihawi H, Sharma R, Yoon SH, Pichard AD, Kapadia S, Reardon MJ, Bhatt DL, Fontana GP. Self-expanding intra-annular versus commercially available transcatheter heart valves in high and extreme risk patients with severe aortic stenosis (PORTICO IDE): a randomised, controlled, non-inferiority trial. Lancet. 2020 Sep 5;396(10252):669-683. doi: 10.1016/S0140-6736(20)31358-1. Epub 2020 Jun 25. Erratum In: Lancet. 2020 Sep 5;396(10252):668.
• Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, De Backer O, Asch FM, Ruiz CE, Olsen NT, Trento A, Friedman J, Berman D, Cheng W, Kashif M, Jelnin V, Kliger CA, Guo H, Pichard AD, Weissman NJ, Kapadia S, Manasse E, Bhatt DL, Leon MB, Sondergaard L. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med. 2015 Nov 19;373(21):2015-24. doi: 10.1056/NEJMoa1509233. Epub 2015 Oct 5.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2014
• Primary Completion (Actual): October 1, 2019
• Study Completion (Estimated): July 1, 2025

Study Registration Dates

• First Submitted: November 26, 2013
• First Submitted That Met QC Criteria: November 26, 2013
• First Posted (Estimated): December 3, 2013

Study Record Updates

• Last Update Posted (Actual): October 25, 2023
• Last Update Submitted That Met QC Criteria: October 24, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: Portico
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Aortic Valve Disease; Heart Valve Diseases; Ventricular Outflow Obstruction; Aortic Valve Stenosis
• Other Study ID Numbers: 1203 (PI)