TORCH-LATAM-003: Regional Advanced-Therapy Pathways for Congenital Heart Disease (TORCH-003)
A Stepped-Wedge Cluster Randomized Trial of the TORCH Congenital Advanced Therapies Pathway for Children and Adults With Congenital Heart Disease in Latin America
TORCH-LATAM-003 is a pragmatic stepped-wedge cluster randomized trial evaluating a regional pathway for children and adults with congenital heart disease and advanced cardiac and/or respiratory failure who may require heart, lung, or heart-lung transplantation, mechanical circulatory or extracorporeal support, or another regulated advanced-therapy pathway. Clusters transition from usual local pathways to TORCH-CATP. The primary outcome is completion of the prespecified multidisciplinary evaluation and documentation of an advanced-pathway decision within 90 days after enrollment. The study also evaluates barriers, authorized pathway or waiting-list activation, longitudinal status, advanced support, definitive therapy, and clinical outcomes. Donor-organ and matching events are captured only where legally authorized and do not replace national allocation systems or transplant-center decisions.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Each TORCH regional network cluster is anchored in an authorized advanced-therapy or transplant center and may include activated evaluation, referral, congenital cardiology, pulmonary hypertension, intensive-care, mechanical-support, donor-origin, procurement, preservation, logistics, and data-coordination nodes. Children and adults with congenital heart disease may be identified at transplanting or non-transplanting centers when an authorized route to specialized evaluation exists. Authorized centers and competent authorities retain all legal and clinical authority for candidacy, waiting-list activation, organ acceptance, allocation, and transplantation.
The recipient pathway records identification, referral, enrollment, completion of multidisciplinary congenital evaluation, a documented advanced-pathway decision, barrier management, activation of an authorized pathway or official waiting list, longitudinal clinical and support status, transplantation, regulated external-protocol enrollment, or an alternative outcome. Study enrollment is analytically distinct from advanced-therapy candidacy and official wait-list status.
The pathway permits clinically documented redirection among heart, lung, heart-lung, or other authorized transplant evaluation; temporary or durable mechanical support; recovery; surveillance; palliative care; and independently governed investigational protocols. TORCH does not assign an investigational therapy, device, cell, organoid, or xenograft and does not infer efficacy or safety for such products.
Where legally authorized, donor-organ and recipient pathways converge at traceable compatibility and offer episodes. Each decision, non-acceptance reason, reassignment, urgency change, distance, logistics constraint, and final disposition is time-stamped. TORCH does not create a supranational allocation authority or override governmental or institutional systems.
Interoperability may range from audited manual transfer to structured documents, batch exchange, application programming interfaces, standards-based exchange, or validated remote-monitoring devices. Cross-border activity is activated only after applicable ethical, regulatory, institutional, data-protection, financial, and operational approvals.
Undersøgelsestype
Tilmelding (Anslået)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Eliecer Villamizar De La Hoz, MD
- Telefonnummer: +50370878226
- E-mail: info@torch-latam.org
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Child or adult of any age with congenital heart disease; enrollment of minors requires parent or legal-representative permission and assent when applicable.
- Congenital heart disease with advanced cardiac and/or respiratory failure, associated pulmonary hypertension, or another protocol-defined trigger for specialized advanced-therapy evaluation.
- Identification within an activated TORCH network cluster with an operational route to at least one authorized advanced-therapy or transplant center.
- Ability to complete protocol-defined follow-up directly or through an authorized network pathway.
- Provision of informed consent by the participant or legally authorized representative, and assent when applicable, according to local requirements.
Exclusion Criteria:
- Absence of congenital heart disease as the underlying condition defining the advanced cardiac and/or respiratory-failure pathway.
- No authorized route for protocol evaluation or follow-up at the time of enrollment.
- Unable or unwilling to provide informed consent or legally authorized permission when required.
- The prespecified multidisciplinary evaluation and advanced-pathway decision were already completed and remain clinically current before enrollment.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Sundhedstjenesteforskning
- Tildeling: Randomiseret
- Interventionel model: Sekventiel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: TORCH-CATP Intervention Period
Participants enrolled while their cluster is assigned to the intervention period receive the TORCH Congenital Advanced Therapies Pathway, including protocolized identification and referral, multidisciplinary evaluation, pathway-decision adjudication, barrier navigation, pathway and waiting-list status tracking, and traceable donor-organ opportunity coordination when applicable. |
A multicomponent health-services pathway that standardizes identification, referral, multidisciplinary congenital-heart-disease evaluation, advanced-pathway decision documentation, barrier navigation, longitudinal waiting-list and support status, authorized donor-organ and matching traceability, and secure information exchange. It does not assign organs, authorize therapies, or replace transplant-center or governmental decisions. |
|
Ingen indgriben: Usual Local Pathway Period
Participants enrolled before their cluster transitions to TORCH-CATP receive locally available referral, evaluation, treatment, support, and transplant-candidacy processes. Study data collection does not alter the authority of local programs or competent authorities. |
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Completion of Multidisciplinary Congenital Advanced-Therapy Evaluation and Documented Pathway Decision Within 90 Days
Tidsramme: Within 90 days after enrollment.
|
Percentage of eligible enrolled participants who complete the prespecified multidisciplinary congenital advanced-therapy evaluation and have a documented advanced-pathway decision within 90 days after enrollment. APD-A, APD-B, APD-D, APD-E, APD-F, APD-G, and APD-H count as completed decisions when the minimum evaluation is complete. APD-C denotes incomplete evaluation and is not counted as success. Death, irreversible deterioration, or missing evidence before day 90 is not counted as success unless the minimum evaluation and a valid decision were documented. |
Within 90 days after enrollment.
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Activation of an Authorized Advanced-Therapy Pathway or Official Waiting List
Tidsramme: Within 180 days after the first documented advanced-pathway decision qualifying for activation.
|
Percentage of participants with a qualifying advanced-pathway decision who achieve documented activation of an authorized pathway or official waiting list. Enrollment alone is not activation. |
Within 180 days after the first documented advanced-pathway decision qualifying for activation.
|
|
Time to Completed Multidisciplinary Evaluation and Advanced-Pathway Decision
Tidsramme: From enrollment to completed evaluation and documented advanced-pathway decision, assessed through 180 days.
|
Time from enrollment to completion of the prespecified multidisciplinary evaluation and documentation of a valid advanced-pathway decision. |
From enrollment to completed evaluation and documented advanced-pathway decision, assessed through 180 days.
|
|
Redirection of the Advanced-Therapy Pathway
Tidsramme: Through 24 months after enrollment.
|
Percentage of enrolled participants with a documented change in intended advanced therapy or destination pathway, with origin, destination, authority, and reason recorded. |
Through 24 months after enrollment.
|
|
Waiting-List Status or Urgency Transition
Tidsramme: At each documented waiting-list transition through 24 months after enrollment.
|
Number and distribution of documented waiting-list status or urgency transitions by reason among participants with an official waiting-list episode. |
At each documented waiting-list transition through 24 months after enrollment.
|
|
Initiation of Temporary Mechanical Circulatory or Extracorporeal Life Support
Tidsramme: Through 24 months after enrollment.
|
Percentage of enrolled participants with initiation of protocol-defined temporary mechanical circulatory support or extracorporeal life support; organ supported, configuration, and therapeutic intent are classified. |
Through 24 months after enrollment.
|
|
Durable Mechanical Support Implantation
Tidsramme: Through 24 months after enrollment.
|
Percentage of enrolled participants receiving protocol-defined durable mechanical circulatory or respiratory support; device category and therapeutic strategy are reported separately. |
Through 24 months after enrollment.
|
|
Transplantation by Organ Type
Tidsramme: Through 24 months after enrollment.
|
Percentage of enrolled participants who undergo heart, lung, or heart-lung transplantation, reported separately by organ type. |
Through 24 months after enrollment.
|
|
Survival Free From Irreversible Clinical Deterioration
Tidsramme: At 90 days, 1 year, and 2 years after enrollment.
|
Percentage of enrolled participants alive without protocol-defined irreversible deterioration that precludes the intended advanced-therapy pathway at each prespecified time point. |
At 90 days, 1 year, and 2 years after enrollment.
|
|
Resolution of Identified Barriers
Tidsramme: Within 180 days after identification of each barrier.
|
Percentage of prespecified clinical, administrative, financial, regulatory, logistical, geographic, social, technological, or information barriers documented as resolved according to the barrier-specific rule; each barrier is the unit of analysis. |
Within 180 days after identification of each barrier.
|
|
Authorized Enrollment in an External Advanced-Therapy Protocol
Tidsramme: 24 months after enrollment.
|
Percentage of enrolled participants who provide protocol-specific consent and are formally enrolled in an independently governed advanced-therapy protocol. Referral, contact, screening, or APD-G alone is not enrollment. This outcome measures access and not efficacy or safety of the external product. |
24 months after enrollment.
|
|
Utilization of TORCH-Evaluated Donor Organs
Tidsramme: At final disposition of each donor organ, during the perioperative/periprocedural period, including implantation, recovery without implantation, or documented non-use.
|
Percentage of donor organs meeting the prespecified evaluable-opportunity denominator that are implanted. Final disposition is classified as implanted, recovered but not implanted, or not recovered, with prespecified reasons for non-use recorded. |
At final disposition of each donor organ, during the perioperative/periprocedural period, including implantation, recovery without implantation, or documented non-use.
|
Samarbejdspartnere og efterforskere
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Eliecer Villamizar De La Hoz, MD, CardioVision International Tech S.A. de C.V.
Publikationer og nyttige links
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- TORCH-LATAM-003
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