Real World Expanded Multicenter Study of the MitraClip® System (REALISM)

NCT ID: NCT01931956

Last Updated: 2018-12-04

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

965 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-01-22

Study Completion Date

2018-06-30

Brief Summary

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Prospective, multicenter, continued access registry of the MitraClip® Cardiovascular Valve Repair System in the treatment of mitral valve regurgitation. Patients will undergo 30-day, 6-month, 12-month, 36-month and 60-month clinical follow-up. The study consists of two arms: a High Risk group (NCT01940120) and a Non-High Risk group (NCT00209274) . 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).

Detailed Description

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The EVEREST II REALISM study (REALISM study) is a continued access registry designed for continued data collection on the use of Abbott Vascular's MitraClip System (MitraClip® Device) under more "real world" conditions. After the completion of enrollment in the pivotal EVEREST II Randomized Controlled Trial (RCT) NCT00209274 and EVEREST II High Risk Registry Study NCT01940120, continued access to the technology was warranted to collect additional safety and effectiveness data on the MitraClip® Device. This continued access study was approved by FDA on November 21, 2008 (G030064). There are two arms (High Risk and Non-High Risk) in the REALISM study. 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). Enrollment in the Non-High Risk arm of the study concluded on April 14, 2011 and enrollment in the High Risk arm concluded on December 19, 2013.

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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Mitral Valve Insufficiency Mitral Valve Regurgitation Mitral Valve Incompetence Mitral Regurgitation Mitral Insufficiency

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

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.

Group Type EXPERIMENTAL

MitraClip® implant

Intervention Type DEVICE

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.

Group Type EXPERIMENTAL

MitraClip® implant

Intervention Type DEVICE

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.

Group Type EXPERIMENTAL

MitraClip® implant

Intervention Type DEVICE

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.

Group Type EXPERIMENTAL

MitraClip® implant

Intervention Type DEVICE

Percutaneous mitral valve repair using MitraClip implant

Interventions

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MitraClip® implant

Percutaneous mitral valve repair using MitraClip implant

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* The primary regurgitant jet originates from malcoaptation of the A2 and P2 scallops of the mitral valve (MV)
* 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

* Evidence of an Acute Myocardial Infarction (AMI) in the prior 12 weeks of the intended treatment
* 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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Abbott Medical Devices

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

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

Site Status

El Camino Hospital

Mountain View, California, United States

Site Status

University of California Davis Medical Center

Sacramento, California, United States

Site Status

University of Colorado Health Sciences Center

Aurora, Colorado, United States

Site Status

Washington Hospital Center

Washington D.C., District of Columbia, United States

Site Status

Baptist Hospital of Miami, FL

Miami, Florida, United States

Site Status

Piedmont Hospital

Atlanta, Georgia, United States

Site Status

St. Joseph's Hospital

Atlanta, Georgia, United States

Site Status

Rush University Medical Center

Chicago, Illinois, United States

Site Status

Evanston Hospital

Evanston, Illinois, United States

Site Status

The Care Group Medical Center (St. Vincent Hospital)

Indianapolis, Indiana, United States

Site Status

Shawnee Mission Medical Center

Shawnee Mission, Kansas, United States

Site Status

Terrebonne General Medical Center

Houma, Louisiana, United States

Site Status

Maine Medical Center

Portland, Maine, United States

Site Status

William Beaumont Hospital

Royal Oak, Michigan, United States

Site Status

Minneapolis Heart Institute

Minneapolis, Minnesota, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

St. Patrick's Hospital & Health Science Center

Missoula, Montana, United States

Site Status

Morristown Memorial Hospital

Morristown, New Jersey, United States

Site Status

New York University Medical Center

New York, New York, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

New York Presbyterian Hospital

New York, New York, United States

Site Status

Lenox Hill Hospital

New York, New York, United States

Site Status

St. Francis Hospital

Roslyn, New York, United States

Site Status

Carolina's Medical Center (Sanger Clinic)

Charlotte, North Carolina, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

East Carolina Heart Institute

Greenville, North Carolina, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

Oklahoma Heart Hospital

Oklahoma City, Oklahoma, United States

Site Status

Hospital of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Baylor University Medical Center

Dallas, Texas, United States

Site Status

Memorial Hermann Hospital

Houston, Texas, United States

Site Status

University of Texas Health Science Center

San Antonio, Texas, United States

Site Status

Intermountain Medical Center

Murray, Utah, United States

Site Status

University of Virginia Health System

Charlottesville, Virginia, United States

Site Status

Swedish Medical Center

Seattle, Washington, United States

Site Status

St. Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status

Countries

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United States

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.

Reference Type RESULT
PMID: 21741608 (View on PubMed)

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.

Reference Type RESULT
PMID: 23608290 (View on PubMed)

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.

Reference Type RESULT
PMID: 25011722 (View on PubMed)

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.

Reference Type DERIVED
PMID: 30586701 (View on PubMed)

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.

Reference Type DERIVED
PMID: 25593120 (View on PubMed)

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.

Reference Type DERIVED
PMID: 24184254 (View on PubMed)

Related Links

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https://www.vascular.abbott/us/homepage.html

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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