- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04402931
Randomized Trial of Transcatheter Valve-in-Valve vs Redo Surgery for Bioprosthetic Mitral Dysfunction
Randomized Trial of Transcatheter Valve-in-Valve Intervention vs Redo Surgery for the Treatment of Structural Mitral Bioprosthetic Dysfunction
Study Overview
Status
Intervention / Treatment
Detailed Description
Prospective, randomized, controlled trial of transeptal, transcatheter mitral valve-in-valve versus redo surgical mitral valve replacement.
After multidisciplinary, heart team discussion, patients meeting inclusion criteria will be randomized 1:1 to receive either transcatheter, transeptal mitral valve-in-valve replacement (TsMViV) with the SAPIEN 3 transcatheter heart valve (THV) or redo, mitral valve replacement with 3 commercially available surgical bioprosthetic valves. A sub-randomization in the surgical group will define which bioprosthetic valve will be used. Patients will be seen for follow-up visits at discharge, 30 days, 6 months and annually through 10 years.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dimytri Siqueira, MD, PhD
- Phone Number: +5511994516856
- Email: dimytrisiqueira@gmail.com
Study Contact Backup
- Name: Renata Viana, MD
- Phone Number: +551150856325
- Email: rviana@dantepazzanese.org.br
Study Locations
-
-
-
São Paulo, Brazil, 04012909
- Recruiting
- Instituto Dante Pazzanese de Cardiologia
-
Contact:
- Dimytri A Siqueira, MD, PhD
-
Principal Investigator:
- DImytri A Siqueira, MD, PhD
-
Principal Investigator:
- Alexandre A Abizaid, MD, PhD
-
Principal Investigator:
- Auristela A Ramos, MD, PhD
-
Principal Investigator:
- Fausto Feres, MD, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age<70 years;
- Symptoms of heart failure NYHA class>ll;
- Severe mitral bioprosthetic dysfunction (stenosis, regurgitation, mixed) defined by echocardiography;
- Heart team (including cardiac surgeon) agree on eligibility including assessment that transeptal, transcatheter mitral valve replacement (TsMVR) and redo surgical mitral valve replacement (rSMVR) are appropriate;
- The study patient or the study patient's legal representative informed of the nature of the study, agreed to its provisions and provided written informed consent as approved by the Institutional Review Board (IRB) center;
- The study patient agreed to comply with all required post- procedure follow-up visits including annual visits through 10 years and analysis close date visits, which was conducted as a phone follow-up;
- Heart team agreed (a priori) on treatment strategy for concomitant coronary disease (if present);
- Patient agreed to undergo redo surgical mitral valve replacement (rSMVR) if randomized to control treatment.
Exclusion Criteria:
- Heart Team assessment of inoperability (including examining cardiac surgeon);
- Hostile chest;
- Evidence of an acute myocardial infarction < 1 month (30 days) before the intended treatment [defined as: Q wave Ml, or non-Q wave Ml with total creatine kinase (CK), creatine kinase MB isoform (CK-MB) and/or cardiac troponin elevations (WHO definition)];
- Concomitant severe valvular disease (aortic, tricuspid or pulmonic) requiring surgical intervention;
- Mitral mechanical prosthesis or mitral valve rings;
- Preexisting mechanical or bioprosthetic valve in other position with dysfunction;
- Complex coronary artery disease: unprotected left main coronary artery, Syntax score > 32 (in the absence of prior revascularization);
- Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 30 days of the index procedure (unless part of planned strategy for treatment of concomitant coronary artery disease). Implantation of a permanent pacemaker is not an exclusion criteria;
- Patients with planned concomitant surgical or transcatheter ablation for atrial fibrillation;
- Leukopenia (WBC < 3000 cell/mL), acute anemia (Hgb< 9 g/dL), thrombocytopenia (Pht< 50,000 cell/mL);
- Hypertrophic cardiomyopathy with or without obstruction (HOCM);
- Severe ventricular dysfunction with left-ventricular ejection fraction (LVEF) < 20%;
- Echocardiographic evidence of intracardiac mass, thrombus or vegetation;
- Active upper gastrointestinal (GI) bleeding within 3 months (90 days) prior to procedure;
- A known contraindication or hypersensitivity to all anticoagulation regimens, or inability to be anticoagulated for the study procedure;
- Clinically (by neurologist) or neuroimaging confirmed stroke or transient ischemic attack (TIA) within 3 months (90 days) of the procedure;
- Renal insufficiency (creatinine > 3.0 mg/dL) and/or renal replacement therapy at the time of screening;
- Estimated life expectancy < 24 months (730 days) due to carcinomas, chronic liver disease, chronic renal disease or chronic end stage pulmonary disease;
- Currently participating in an investigational drug or another device study;
- Active bacterial endocarditis within 6 months (180 days) of procedure;
- Patient refuses redo mitral valve replacement surgery.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
OTHER: Transcatheter Valve-in-Valve Intervention
|
Transcatheter mitral valve-in-valve implantation with SAPIEN 3
|
OTHER: Redo Surgery
Surgical Mitral valve replacement
|
Transcatheter Valve-in-Valve Intervention
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of Major cardiovascular and Cerebrovascular events
Time Frame: 12 months
|
All-cause death; Cardiovascular death; Disabling stroke (neurologist assessment)
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of Procedure-related complications
Time Frame: 30 days
|
Major vascular complications;
|
30 days
|
Rate of Rehospitalization
Time Frame: 12 months
|
Rehospitalization at 12 months
|
12 months
|
Rate of Prosthetic Thrombosis
Time Frame: 3 and 12 months
|
Prosthetic thrombosis at 3- and 12 months (as assessed by transesophageal echocardiography and multi-slice tomography).
|
3 and 12 months
|
Rate of Structural Valve dysfunction (as assessed by transthoracic echocardiography)
Time Frame: 10 years
|
Structural valve dysfunction assessed annually, up to 10-year follow-up.
|
10 years
|
Rate of Bioprosthetic Valve Failure (as assessed by clinical outcomes and echocardiographic evaluations)
Time Frame: 10 years
|
Bioprosthetic valve failure assessed annually, up to 10-year follow-up.
|
10 years
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Dimytri Siqueira, MD, PhD, Instituto Dante Pazzanese de Cardiologia
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- 4993/2019
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Mitral Prosthetic Valve Stenosis and Regurgitation
-
Abbott Medical DevicesCompletedMitral Valve Regurgitation | Mitral Valve Incompetence | Mitral Insufficiency | Functional Mitral Regurgitation | Mitral Stenosis With InsufficiencyJapan
-
Konkuk University Medical CenterCompletedMitral Regurgitation | Tricuspid Regurgitation | Mitral StenosisKorea, Republic of
-
Konkuk University Medical CenterCompletedMitral Regurgitation | Tricuspid Regurgitation | Mitral StenosisKorea, Republic of
-
Foldax, IncActive, not recruitingMitral Regurgitation | Mitral Valve Insufficiency | Mitral Valve Disease | Mitral StenosisIndia
-
Edwards LifesciencesNot yet recruitingMitral Regurgitation | Mitral Valve Disease | Mitral Stenosis
-
Braile Biomedica Ind. Com. e Repr. Ltda.RecruitingAortic Valve Stenosis | Mitral Valve Insufficiency | Aortic Valve Insufficiency | Mitral Valve Stenosis | Mitral Valve Regurgitation | Aortic Valve Incompetence | Mitral Valve Incompetence | Aortic Valve RegurgitationBrazil
-
Deutsches Herzzentrum MuenchenRecruitingMitral Valve Stenosis | Mitral Valve Regurgitation | Tricuspid Valve RegurgitationGermany
-
Abbott Medical DevicesCompletedAortic Valve Stenosis | Mitral Valve Insufficiency | Aortic Valve Insufficiency | Mitral Valve Stenosis | Mitral Valve Regurgitation | Aortic Valve Incompetence | Mitral Valve Incompetence | Aortic Valve RegurgitationUnited States
-
University of ManitobaRecruitingSevere Aortic Valve Stenosis | Severe Mitral Valve RegurgitationCanada
-
Xiamen Cardiovascular Hospital, Xiamen UniversityRecruitingHeart Failure | Mitral Regurgitation | Mitral Stenosis | Mitral Stenosis With Insufficiency | Bioprosthesis FailureChina
Clinical Trials on Transcatheter Valve-in-Valve Intervention
-
Medical University of WarsawRecruitingAortic Valve Stenosis | Aortic Valve Insufficiency | Ventricular Outflow Obstruction, LeftPoland
-
Medical University of WarsawInstitute of Cardiology, Warsaw, Poland; Medical University of Lodz; Medical... and other collaboratorsRecruitingHeart Failure | Mitral Insufficiency | Mitral Stenosis | Mitral Stenosis With Insufficiency | Bioprosthesis FailurePoland
-
Xiamen Cardiovascular Hospital, Xiamen UniversityRecruitingHeart Failure | Mitral Regurgitation | Mitral Stenosis | Mitral Stenosis With Insufficiency | Bioprosthesis FailureChina
-
Guy's and St Thomas' NHS Foundation TrustKing's College Hospital NHS Trust; Royal Brompton & Harefield NHS Foundation... and other collaboratorsNot yet recruitingMitral Regurgitation
-
Universitaire Ziekenhuizen KU LeuvenRecruitingHeart Valve DiseasesBelgium
-
Jenscare ScientificRecruitingTricuspid RegurgitationFrance
-
Clinique PasteurUnknownBicuspid Aortic ValveFrance
-
Didier TCHETCHEAbbottNot yet recruitingBicuspid Aortic ValveFrance
-
Ottawa Heart Institute Research CorporationEnrolling by invitationTricuspid RegurgitationUnited States, Spain, Israel, Canada, France, Germany, Netherlands, Switzerland, Austria, Italy
-
Medical University InnsbruckRecruitingHeart Failure | Aortic Stenosis | Angina Pectoris | SyncopeAustria