Real World Expanded Multicenter Study of the MitraClip® System (REALISM)
NCT ID: NCT01931956
Last Updated: 2018-12-04
Study Results
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View full resultsBasic Information
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COMPLETED
NA
965 participants
INTERVENTIONAL
2009-01-22
2018-06-30
Brief Summary
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Detailed Description
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REALISM is a prospective, multi-center, study of the safety and effectiveness of an endovascular approach to the treatment of mitral valve regurgitation using the Evalve Cardiovascular Valve Repair System (MitraClip® implant). Patients with moderate-to-severe (3+) or severe (4+) mitral regurgitation (MR), as determined by the site from a transthoracic echocardiogram (TTE), were considered for enrollment in this study. The TTE and a transesophageal echocardiogram (TEE) are used to assess eligibility criteria for MR severity, valve anatomy and left ventricular parameters.
Conditions
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Study Design
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NON_RANDOMIZED
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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Non-High Risk
Includes patients who are candidate for mitral valve repair or replacement surgery, including cardiopulmonary bypass (i.e. non-high risk). The patients who are enrolled in this arm will undergo percutaneous mitral valve repair using MitraClip® implant. This arm was evaluated as a separate study NCT00209274.
MitraClip® implant
Percutaneous mitral valve repair using MitraClip implant
High Risk
Includes patients with a predicted procedural mortality risk calculated using the Society For Thoracic Surgeon (STS) surgical risk calculator of ≥12% or, in the judgment of a cardiac surgeon, the patient is considered a high risk surgical candidate due to the presence of pre-defined risk factors. The patients who are enrolled in this arm will undergo percutaneous mitral valve repair using MitraClip® implant. This arm was evaluated as a separate study NCT01940120.
MitraClip® implant
Percutaneous mitral valve repair using MitraClip implant
Compassionate Use
Patients that did not meet REALISM High Risk or Non-High Risk eligibility criteria were evaluated for consideration for either Emergency Use (EU) or Compassionate Use (CU). The objective of the Compassionate and Emergency Use Group of the EVEREST II REALISM study is to provide access to the MitraClip Device, in a non-commercial setting, for patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable. The patients who are enrolled in this arm will undergo percutaneous mitral valve repair using MitraClip® implant.
MitraClip® implant
Percutaneous mitral valve repair using MitraClip implant
Emergency Use
Patients that did not meet REALISM High Risk or Non-High Risk eligibility criteria were evaluated for consideration for either Emergency Use (EU) or Compassionate Use (CU). The objective of the Compassionate and Emergency Use Group of the EVEREST II REALISM study is to provide access to the MitraClip Device, in a non-commercial setting, for patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable. The patients who are enrolled in this arm will undergo percutaneous mitral valve repair using MitraClip® implant.
MitraClip® implant
Percutaneous mitral valve repair using MitraClip implant
Interventions
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MitraClip® implant
Percutaneous mitral valve repair using MitraClip implant
Eligibility Criteria
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Inclusion Criteria
* Male or non-pregnant female
* Trans-septal catheterization is determined to be feasible by the treating physician
High Risk Arm:
* Predicted procedural mortality risk calculated using the STS surgical risk calculator of ≥12% or, in the judgment of a cardiac surgeon, the patient is considered a HR surgical candidate due to the presence of one of the following indications:
1. Porcelain aorta or mobile ascending aortic atheroma
2. Post-radiation mediastinum
3. Previous mediastinitis
4. Functional MR with EF \<40
5. Over 75 years old with EF\<40
6. Re-operation with patent grafts
7. Two or more prior chest surgeries
8. Hepatic cirrhosis
9. Three or more of the following STS high risk factors 9.1 Creatinine \>2.5 mg/dL 9.2 Prior chest surgery 9.3 Age over 75 9.4 EF\<35
* Symptomatic moderate to severe (3+) or severe (4+) chronic MR and in the judgment of the investigator intervention to reduce MR is likely to provide symptomatic relief for the patient
* American Society of Anesthesiologists (ASA) physical status classification of ASA IV or lower
Non-High Risk Arm:
* Moderate to severe (3+) or severe (4+) chronic MV regurgitation and:
1\. Symptomatic with \>25% LVEF and LVESD ≤55mm or, 2. Asymptomatic with one or more of the following: i. Left Ventricular Ejection Fraction (LVEF) 25% to 60% ii. Left Ventricular End-Systolic Diameter (LVESD) ≥40 mm iii. New onset of Atrial fibrillation (AFib) iv. Pulmonary arterial systolic pressure (PASP) \>50 mmHg at rest or \>60 mmHg with exercise
* Candidate for MV repair or replacement surgery, including cardiopulmonary bypass
Exclusion Criteria
* In the judgment of the Investigator, the femoral vein cannot accommodate a 24 French scale (F) catheter or the presence of an inferior vena cava (IVC) filter would interfere with advancement of the catheter or ipsilateral Deep Venous Thrombus (DVT) is present
* MV orifice area \<4.0 cm2
* If leaflet flail is present:
1. Flail Width ≥15 mm, or
2. Flail Gap ≥10 mm.
* If leaflet tethering is present:
1\. Vertical coaptation length \<2 mm
* Leaflet anatomy which may preclude clip implantation, proper clip positioning on the leaflets or sufficient reduction in MR. This may include:
1. Evidence of calcification in the grasping area of the A2 and/or P2 scallops
2. Presence of a significant cleft of A2 or P2 scallops
3. More than one anatomic criteria dimensionally near the exclusion limits
4. Bileaflet flail or severe bileaflet prolapse
5. Lack of both primary and secondary chordal support
* Hemodynamic instability (systolic pressure \<90 mmHg without afterload reduction or cardiogenic shock or the need for inotropic support or intra-aortic balloon pump).
* Need for emergency surgery for any reason
* Prior MV surgery or valvuloplasty or any currently implanted mechanical prosthetic valve or currently implanted Ventricular assist device (VAD)
* Echocardiographic evidence of intracardiac mass, thrombus or vegetation
* Active endocarditis or active rheumatic heart disease or leaflets degenerated from either endocarditis or rheumatic disease (i.e. noncompliant, perforated)
* History of bleeding diathesis or coagulopathy or subject will refuse blood transfusions
* Life expectancy \<12 months
* Active infections requiring current antibiotic therapy
* Patients in whom transesophageal echocardiography (TEE) is contraindicated
High Risk Arm:
* EF \<20%, and/or LVESD \>60 mm
Non-High Risk Arm:
* The need for any other cardiac surgery
* Any endovascular therapeutic interventional or surgical procedure performed within 30 days prior to the index procedure
* Severe Left Ventricular (LV) dysfunction (EF \<25% and/or LVESD \>55mm)
* Severe mitral annular calcification
* Systolic anterior motion of the MV leaflet
* Hypertrophic cardiomyopathy
* History of a stroke or documented Transient Ischemic Attack (TIA) within the prior 6 months
* Upper GI bleeding within the prior 6 months
* Platelet count \<75,000 cells/mm³
* Creatinine \>2.5mg/dL
18 Years
ALL
No
Sponsors
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Abbott Medical Devices
INDUSTRY
Responsible Party
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Principal Investigators
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Ted Feldman, M.D. Feldman, M.D.
Role: STUDY_DIRECTOR
Endeavor Health
Donald D Glower Jr., MD
Role: STUDY_DIRECTOR
Duke University
Locations
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Cedars-Sinai Medical Center
Los Angeles, California, United States
El Camino Hospital
Mountain View, California, United States
University of California Davis Medical Center
Sacramento, California, United States
University of Colorado Health Sciences Center
Aurora, Colorado, United States
Washington Hospital Center
Washington D.C., District of Columbia, United States
Baptist Hospital of Miami, FL
Miami, Florida, United States
Piedmont Hospital
Atlanta, Georgia, United States
St. Joseph's Hospital
Atlanta, Georgia, United States
Rush University Medical Center
Chicago, Illinois, United States
Evanston Hospital
Evanston, Illinois, United States
The Care Group Medical Center (St. Vincent Hospital)
Indianapolis, Indiana, United States
Shawnee Mission Medical Center
Shawnee Mission, Kansas, United States
Terrebonne General Medical Center
Houma, Louisiana, United States
Maine Medical Center
Portland, Maine, United States
William Beaumont Hospital
Royal Oak, Michigan, United States
Minneapolis Heart Institute
Minneapolis, Minnesota, United States
Washington University School of Medicine
St Louis, Missouri, United States
St. Patrick's Hospital & Health Science Center
Missoula, Montana, United States
Morristown Memorial Hospital
Morristown, New Jersey, United States
New York University Medical Center
New York, New York, United States
Columbia University Medical Center
New York, New York, United States
New York Presbyterian Hospital
New York, New York, United States
Lenox Hill Hospital
New York, New York, United States
St. Francis Hospital
Roslyn, New York, United States
Carolina's Medical Center (Sanger Clinic)
Charlotte, North Carolina, United States
Duke University Medical Center
Durham, North Carolina, United States
East Carolina Heart Institute
Greenville, North Carolina, United States
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Oklahoma Heart Hospital
Oklahoma City, Oklahoma, United States
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Medical University of South Carolina
Charleston, South Carolina, United States
Baylor University Medical Center
Dallas, Texas, United States
Memorial Hermann Hospital
Houston, Texas, United States
University of Texas Health Science Center
San Antonio, Texas, United States
Intermountain Medical Center
Murray, Utah, United States
University of Virginia Health System
Charlottesville, Virginia, United States
Swedish Medical Center
Seattle, Washington, United States
St. Luke's Medical Center
Milwaukee, Wisconsin, United States
Countries
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References
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Grayburn PA, Roberts BJ, Aston S, Anwar A, Hebeler RF Jr, Brown DL, Mack MJ. Mechanism and severity of mitral regurgitation by transesophageal echocardiography in patients referred for percutaneous valve repair. Am J Cardiol. 2011 Sep 15;108(6):882-7. doi: 10.1016/j.amjcard.2011.05.013. Epub 2011 Jul 7.
Pope NH, Lim S, Ailawadi G. Late calcific mitral stenosis after MitraClip procedure in a dialysis-dependent patient. Ann Thorac Surg. 2013 May;95(5):e113-4. doi: 10.1016/j.athoracsur.2012.10.067.
Glower DD, Kar S, Trento A, Lim DS, Bajwa T, Quesada R, Whitlow PL, Rinaldi MJ, Grayburn P, Mack MJ, Mauri L, McCarthy PM, Feldman T. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014 Jul 15;64(2):172-81. doi: 10.1016/j.jacc.2013.12.062.
Ailawadi G, Lim DS, Mack MJ, Trento A, Kar S, Grayburn PA, Glower DD, Wang A, Foster E, Qasim A, Weissman NJ, Ellis J, Crosson L, Fan F, Kron IL, Pearson PJ, Feldman T; EVEREST II Investigators. One-Year Outcomes After MitraClip for Functional Mitral Regurgitation. Circulation. 2019 Jan 2;139(1):37-47. doi: 10.1161/CIRCULATIONAHA.117.031733.
Wang A, Sangli C, Lim S, Ailawadi G, Kar S, Herrmann HC, Grayburn P, Foster E, Weissman NJ, Glower D, Feldman T. Evaluation of renal function before and after percutaneous mitral valve repair. Circ Cardiovasc Interv. 2015 Jan;8(1):e001349. doi: 10.1161/CIRCINTERVENTIONS.113.001349.
Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, Whitlow PL, Gray WA, Grayburn P, Mack MJ, Glower DD. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014 Jul 15;64(2):182-92. doi: 10.1016/j.jacc.2013.10.021. Epub 2013 Oct 31.
Related Links
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Web site listing study sites and describing mitral regurgitation, symptoms, clinical consequences and treatments
Other Identifiers
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0401
Identifier Type: OTHER
Identifier Source: secondary_id
0401B
Identifier Type: -
Identifier Source: org_study_id
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