Comparação de uma técnica de perclose simples versus dupla para TAVR (Single)
A utilização de dispositivos de perclose simples versus duplo para fechamento do local de acesso de substituição da válvula aórtica transfemoral: um estudo prospectivo, multicêntrico e controlado randomizado
Transcatheter aortic valve replacement (TAVR) has become widely recognized as a minimally invasive approach for aortic valve replacement in patients with severe aortic stenosis. It has been proven to be a safe and effective option for patients who are at low, intermediate, and prohibitive risk for surgical valve replacement.
One of the critical components of procedural success in a transfemoral approach is access site management, as vascular complications strongly correlate with adverse outcomes. When major vascular complications occur, there are higher rates of major bleeding, transfusions, and renal failure requiring dialysis, as well as a significantly higher rate of 30-day and 1-year mortality. In recent years, a "preclosure" technique has emerged as a common vascular closure approach using a Perclose Proglide system (Abbott Vascular), in which sutures are deployed before dilating the arterial access site. This allows for arterial closure after dilation to sizing up to larger bore access sheaths that accommodate valve delivery systems. The sutures are subsequently harvested and tightened to close the large bore arteriotomy site at the end of the case. It has been demonstrated that the use of two Perclose devices, or double Perclose closure, is an effective closure technique with a low rate of vascular complications. A large number of TAVR centers have adopted this method for large-bore vascular closure. In the past, there have been few investigations comparing the utilization of a single Perclose device compared to a double Perclose technique. There are numerous theoretical advantages to the use of a single device, which include decreased procedural cost and procedural time. The investigation aimed to determine if there are clinical benefits as well using the single Perclose approach.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
SINGLE-CLOSURE (The utilization of Single versus double perclose devices for transfemoral aortIc valve replacement access site Closure) is an investigator-initiated, open-label, multicenter, randomized controlled trial. The study was approved by the local ethics committees of all participating centers, and each patient provided written informed consent for inclusion in the trial. Data management and analysis was performed by an independent data coordinating center, with oversight from a steering committee. The members of the steering committee had full access to the data and vouch for the accuracy and complete- ness of the data and the analyses. The data that support the findings of this study are available from the corresponding author on reasonable request. Patients scheduled to undergo transfemoral TAVR were considered for inclusion in the trial if they met all inclusion and none of the exclusion criteria. Inclusion criteria were an indication for TAVR as judged by the local heart team; selection of the transfemoral access route and a commercially available transcatheter aortic valve; and willingness to comply with protocol specified follow-up evaluations. Principal exclusion criteria were a vascular access site anatomy not suitable for percutaneous vascular closure and the occurrence of vascular access site complications before the TAVR procedure. Additional exclusion criteria were a known allergy or hypersensitivity to any VCD component; unstable active bleeding or bleeding diathesis or significant unman-ageable anemia; absence of computed tomographic data of the access site before the procedure; systemic infection or a local infection at or near the access site; life expectancy of <6 months because of noncardiac conditions; patients who cannot adhere to or complete the investigational protocol for any reason; pregnant or nursing patients; and participation in any other interventional trial.
The primary end point of the trial was the rate of access site or access-related major and minor vascular complications defined according to the Valve Academic Research Consortium-3 criteria. The end point was assessed during index hospitalization. Relationship to the access site was deter- mined according to the site used for the large-bore vascular access sheath.
Secondary end points included the rate of the primary end point at 30 days; components of the primary end point in-hospital and at 30 days; in-hospital and 30-day major and minor vascular complications; unplanned vascular surgery or use of endovascular stent or stent-graft or other endovascular interventions at the puncture site; in-hospital and 30-day access site- or access-related minor, major, and disabling or life threatening bleeding; need for blood transfusion for access site- or access-related bleeding or vascular complications; rate of VCD failure, defined as the failure of a closure device strategy to achieve hemostasis with the need for an alternative treatment (other than manual compression or adjunctive endovascular ballooning); in-hospital and 30-day all-cause death; in-hospital and 30-day death attributed to access site or access-related complications; need and number of additional unplanned VCDs; time to hemostasis, defined as the time from VCD application to complete hemostasis; and the length of postprocedural hospital stay.
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences
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Beijing, China
- Beijing Anzhen Hospital, Capital Medical University
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Anhui
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Bengbu, Anhui, China
- The First Affiliated Hospital of Bengbu Medical College
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Fujian
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Fuzhou, Fujian, China
- Fujian Provincial Hospital
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Gansu
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Lanzhou, Gansu, China
- The First Hospital of Lanzhou University
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Guangdong
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Guangzhou, Guangdong, China
- The First Affiliated Hospital, Sun Yat-sen University
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Guangzhou, Guangdong, China
- Nanfang Hospital, Southern Medical University
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Zhanjiang, Guangdong, China
- The Affiliated Hospital of Guangdong Medical University
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Guangxi
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Yulin, Guangxi, China
- Yulin First People's Hospital
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Henan
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Changshacun, Henan, China
- Xiangya Hospital of Central South University
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Zhengzhou, Henan, China
- Fuwai Central China Cardiovascular Hospital
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Zhengzhou, Henan, China
- Henan Provincial Chest Hospital
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Hunan
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Changsha, Hunan, China
- The Second Xiangya Hospital of Central South University
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Liaoning
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Shenyang, Liaoning, China
- General Hospital of Northern Theater Command, PLA
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Shandong
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Jinan, Shandong, China
- Qilu Hospital of Shandong University
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Qingdao, Shandong, China
- The Affiliated Hospital of Qingdao University
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Qingdao, Shandong, China
- Qingdao Municipal Hospital
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Shanxi
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Xi’an, Shanxi, China
- The First Affiliated Hospital of Xi'an Jiaotong University
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Sichuan
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Chengdu, Sichuan, China
- Sichuan Provincial People's Hospital
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Xinjiang
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Ürümqi, Xinjiang, China
- People's Hospital of Xinjiang Uygur Autonomous Region
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Zhejiang
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Hangzhou, Zhejiang, China, 310000
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University
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Huzhou, Zhejiang, China
- Huzhou Central Hospital
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Ningbo, Zhejiang, China
- The First Affiliated Hospital of Ningbo University
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Ningbo, Zhejiang, China
- Ningbo Medical Center Li Huili Hospital
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Wenzhou, Zhejiang, China
- The First Affiliated Hospital of Wenzhou Medical University
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Patients scheduled to undergo transfemoral TAVR were considered for inclusion in the trial if they met all inclusion and none of the exclusion criteria. Inclusion criteria were an indication for TAVR as judged by the local heart team; selection of the transfemoral access route and a commercially available transcatheter aortic valve; and willingness to comply with protocol specified follow-up evaluations.
Exclusion Criteria:
- Principal exclusion criteria were a vascular access site anatomy not suitable for percutaneous vascular closure and the occurrence of vascular access site complications before the TAVR procedure. Additional exclusion criteria were a known allergy or hypersensitivity to any VCD component; unstable active bleeding or bleeding diathesis or significant unman ageable anemia; absence of computed tomographic data of the access site before the procedure; systemic infection or a local infection at or near the access site; life expectancy of <6 months because of noncardiac conditions; patients who can-not adhere to or complete the investigational protocol for any reason; pregnant or nursing patients; and participation in any other interventional trial.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Comparador Ativo: Double Perclose device
Double Perclose device ( Perclose Proglide system, Abbott Vascular) was used for large bore arteriotomy site closure during TF-TAVR procedures |
"Preclosure" technique has emerged as a common vascular closure approach using a Perclose Proglide system (Abbott Vascular), in which sutures are deployed before dilating the arterial access site. |
|
Experimental: Single Perclose device
Single Perclose device ( Perclose Proglide system, Abbott Vascular) was used for large bore arteriotomy site closure during TF-TAVR procedures |
"Preclosure" technique has emerged as a common vascular closure approach using a Perclose Proglide system (Abbott Vascular), in which sutures are deployed before dilating the arterial access site. |
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
The primary end point of the trial was the rate of access site or access-related major and minor vascular complications defined according to the Valve Academic Research Consortium-3 criteria
Prazo: The end point was assessed during index hospitalization
|
|
The end point was assessed during index hospitalization
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
The rate of the primary end point at 30 days
Prazo: 30 days
|
the rate of access site or access-related major and minor vascular complications at 30 days |
30 days
|
|
Components of the primary end point in-hospital and at 30 days
Prazo: 30 days
|
Components of the rate of access site or access-related major and minor vascular complications at 30 days |
30 days
|
|
In-hospital and 30-day major and minor vascular complications
Prazo: 30 days
|
In-hospital and 30-day major and minor vascular complications |
30 days
|
|
Unplanned vascular surgery or use of endovascular stent or stent-graft or other endovascular interventions at the puncture site
Prazo: 30 days
|
Unplanned vascular surgery or use of endovascular stent or stent-graft or other endovascular interventions at the puncture site at 30 days |
30 days
|
|
in-hospital and 30-day access site- or access-related minor, major, and disabling or life- threatening bleeding; need for blood transfusion for access site or access related bleeding or vascular complications
Prazo: 30 days
|
in-hospital and 30-day access site- or access-related minor, major, and disabling or life- threatening bleeding; need for blood transfusion for access site or access related bleeding or vascular complications |
30 days
|
|
Rate of VCD failure, defined as the failure of a closure device strategy to achieve hemostasis with the need for an alternative treatment (other than manual compression or adjunctive endovascular ballooning)
Prazo: 30 days
|
Rate of VCD failure, defined as the failure of a closure device strategy to achieve hemostasis with the need for an alternative treatment (other than manual compression or adjunctive endovascular ballooning) at 30 days |
30 days
|
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In-hospital and 30-day all-cause death; in-hospital and 30-day death attributed to access site- access-related complications; need and number of additional unplanned VCDs
Prazo: 30 days
|
In-hospital and 30-day all-cause death; in-hospital and 30-day death attributed to access site- access-related complications; need and number of additional unplanned VCDs |
30 days
|
|
Time to hemostasis, defined as the time from VCD application to complete hemostasis
Prazo: 30 days
|
Time to hemostasis, defined as the time from VCD application to complete at 30 days |
30 days
|
|
The length of postprocedural hospital stay
Prazo: 30 days
|
The length of postprocedural hospital stay |
30 days
|
Colaboradores e Investigadores
Investigadores
- Cadeira de estudo: Jianan Wang, PhD, Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- SAHZJU CT022
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