Effect of Double-Tap Optimization on Valve Expansion and Hemodynamics in Balloon-expandable Transcatheter Aortic Valve Implantation: A Randomized Clinical Trial (DO-OPT TAVI Trial)
This study will compare two balloon inflation strategies during transcatheter aortic valve implantation (TAVI), a procedure used to replace a severely narrowed aortic valve through a catheter. A balloon-expandable replacement valve may not fully expand during its initial placement. An additional inflation using the same balloon and the same inflation volume, called "Double-Tap," may improve valve expansion and function. Its benefits and risks need to be evaluated in a randomized trial.
This prospective, multicenter study aims to include 250 adults with symptomatic severe aortic stenosis undergoing TAVI with an Edwards SAPIEN-family balloon-expandable valve. After successful valve implantation, participants for whom an additional inflation is considered technically feasible and clinically appropriate will be randomly assigned in equal numbers to Double-Tap or conventional single inflation. Patients requiring therapeutic post-dilatation for moderate or greater leakage around the implanted valve will not undergo randomization.
The main question is whether Double-Tap improves valve expansion immediately after TAVI, as measured using fluoroscopic X-ray images. The study will also compare blood flow through the valve, valve expansion and signs of valve thrombosis on cardiac computed tomography, procedure-related complications, and clinical outcomes. Participants will undergo echocardiography before discharge and at 3-6 and 12 months, and cardiac computed tomography at 3-6 months. Clinical follow-up will continue for at least 12 months, with annual follow-up thereafter until the last enrolled participant completes the 12-month visit.
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Young-Guk Ko, Professor
- Telefoonnummer: +82-22228-8460
- E-mail: ygko@yuhs.ac
Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Patients ≥ 19 years old
- Patients undergoing TAVI using a Sapien family valve for severe AS
- Provision of informed consent
Exclusion criteria:
- Subannular calcification
- Bicuspid aortic valve with raphe calcification
- Valve-in-valve TAVI procedure
- Planned major surgery
- Cardiogenic shock or hemodynamic instability
- Chronic kidney disease stage 3b, 4, or 5 (eGFR <45mL/min)
- Thrombocytopenia (platelet count <100,000) or contraindication to antiplatelet therapy or anticoagulation despite clinical indications
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
|
Experimenteel: Double-Tap
Participants undergo TAVI with an Edwards SAPIEN-family balloon-expandable valve. After successful initial valve implantation and randomization, one additional balloon inflation is performed using the same delivery balloon and the same inflation volume used for initial deployment. The additional inflation is performed immediately after confirming appropriate valve position and procedural stability. |
Following successful implantation of an Edwards SAPIEN-family balloon-expandable transcatheter heart valve, one additional balloon inflation is performed using the same delivery balloon and the same inflation volume used for initial valve deployment. Balloon inflation volume is not increased for the Double-Tap inflation. The procedure is performed after randomization and confirmation of appropriate valve position and procedural stability. |
|
Actieve vergelijker: No Double-Tap
Participants undergo standard TAVI with an Edwards SAPIEN-family balloon-expandable valve deployed using a single balloon inflation. After successful initial valve implantation and randomization, no planned additional balloon inflation for Double-Tap optimization is performed. |
An Edwards SAPIEN-family balloon-expandable transcatheter heart valve is implanted using a single balloon inflation according to standard practice and the manufacturer's instructions for use. No planned additional balloon inflation for Double-Tap optimization is performed after randomization. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Percentage valve expansion measured by fluoroscopy
Tijdsspanne: immediately after TAVI procedure
|
Expansion of the implanted transcatheter heart valve, expressed as a percentage of the manufacturer's nominal cross-sectional area for the implanted valve size. Valve diameters are measured at the inflow, midframe, and outflow levels in three-cusp and cusp-overlap fluoroscopic views. At each level, the diameters from the two views are averaged, and the cross-sectional area is calculated using the circular area formula. Fluoroscopic images are evaluated by independent imaging core laboratory assessors blinded to treatment assignment and clinical outcomes. |
immediately after TAVI procedure
|
Medewerkers en onderzoekers
Sponsor
Sponsor
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
Andere studie-ID-nummers
- 4-2026-1423
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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