The Nordic aortic valve intervention (NOTION) trial comparing transcatheter versus surgical valve implantation: study protocol for a randomised controlled trial

Hans Gustav Thyregod, Lars Søndergaard, Nikolaj Ihlemann, Olaf Franzen, Lars Willy Andersen, Peter Bo Hansen, Peter Skov Olsen, Henrik Nissen, Per Winkel, Christian Gluud, Daniel Andreas Steinbrüchel, Hans Gustav Thyregod, Lars Søndergaard, Nikolaj Ihlemann, Olaf Franzen, Lars Willy Andersen, Peter Bo Hansen, Peter Skov Olsen, Henrik Nissen, Per Winkel, Christian Gluud, Daniel Andreas Steinbrüchel

Abstract

Background: Degenerative aortic valve (AV) stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR) has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI) can be offered with improved safety and similar effectiveness in a population including low-risk patients has yet to be examined in a randomised setting.

Methods/design: This randomised clinical trial will evaluate the benefits and risks of TAVI using the transarterial CoreValve System (Medtronic Inc., Minneapolis, MN, USA) (intervention group) compared with SAVR (control group) in patients with severe degenerative AV stenosis. Randomisation ratio is 1:1, enrolling a total of 280 patients aged 70 years or older without significant coronary artery disease and with a low, moderate, or high surgical risk profile. Trial outcomes include a primary composite outcome of myocardial infarction, stroke, or all-cause mortality within the first year after intervention (expected rates 5% for TAVI, 15% for SAVR). Exploratory safety outcomes include procedure complications, valve re-intervention, and cardiovascular death, as well as cardiac, cerebral, pulmonary, renal, and vascular complications. Exploratory efficacy outcomes include New York Heart Association functional status, quality of life, and valve prosthesis and cardiac performance. Enrolment began in December 2009, and 269 patients have been enrolled up to December 2012.

Discussion: The trial is designed to evaluate the performance of TAVI in comparison with SAVR. The trial results may influence the choice of treatment modality for patients with severe degenerative AV stenosis.

Trial registration: ClinicalTrials.gov: NCT01057173.

Figures

Figure 1
Figure 1
The transcatheter aortic valve implantation bioprosthesis. The third-generation porcine pericardial trileaflet valve mounted in a self-expanding nitinol support frame (CoreValve System; Medtronic Inc., Minneapolis, MN, USA). TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Study flow chart. An allcomers trial design. SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.

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