Clinical Study for Evaluating the Safety and Efficacy of Total Endovascular Aortic Arch Repair

NCT ID: NCT03347812

Last Updated: 2017-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

400 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-11-22

Study Completion Date

2020-03-31

Brief Summary

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Aortic disease is a kind of cardiovascular diseases with very high mortality rate and high risk of surgical treatment. At present, the surgical and endovascular treatment for diseases in the ascending aorta, descending aorta and abdominal aorta are becoming more and more mature. However, due to the complexity of the aortic arch in anatomy, function and pathological changes, the optimal treatment strategy for diseases in the aortic arch has been controversial constantly.

This research is a multi-center(four centers), prospective, controlled, large-scale (about 400 subjects) clinical study, using traditional thoracic surgery of aortic arch disease as a control to verify that new techniques for endovascular treatment is not inferior to traditional thoracic surgery in terms of efficiency and safety.

Further more, the investigators plan to explore the indications of the application of these new techniques, develop a better diagnosis and treatment program, reduce the risk of such surgical treatment and the incidence of complications, improve clinical efficacy and the overall quality of the disease.

Detailed Description

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The subjects in this study are patients with aortic arch disease, after scientific assessment made by the team with wide experience in aortic open surgery and endovascular treatment, who are able to both withstand traditional total aortic arch replacement (TAR) and are suitable for complete thoracic endovascular aortic repair (cTEVAR) in terms of anatomical structure. According to the requirement of statistical analysis, more than 400 patients would be enrolled in the four centers (Fuwai Hospital, Peking University People's Hospital, China-Japan Friendship Hospital and Beijing Hospital) within 2 years. Combined the actual situation of the patients, subjects would be divided into TAR and cTEVAR groups. During the study, the investigators would collect the data including blood and biochemical indexes, complications, aortic CT examination, surgical procedure, and the follow-up information in discharge, one month after surgery, six months after surgery and twelve months after surgery.

The primary endpoint of this study is one-year treatment success, which means there are no death within 30 days after surgery, no adverse cardiovascular and no cerebrovascular events and no re-operative intervention associated with aorta occurred during the 1-year follow-up period. Secondary endpoints include the occurrence of postoperative leaks, occlusion, stenosis and thrombosis of aortic arch branches, the incidence of device-related adverse events, and the incidence of other serious complications. This study uses the primary endpoint as a measure of efficacy, and the secondary endpoint as a measure of safety for both treatment methods. The primary analysis of collected data would be based on intention-to-treat (ITT) principle, and all enrolled patients would be included in the final analysis.

The Cochran-Mantel-Haenszel (CMH) chi square analysis for adjusting center effects will be used for comparisons of major indicators, estimating differences in success rates and their 95% confidence intervals in two groups. If the lower limit of the 95% Confidence Interval (CI) of the difference in success rate between the test group and control group exceeds the pre-established non-inferiority cutoff, the endovascular treatment can be considered to be as effective as traditional open surgery. The significance level for all statistical tests is 5%, and the statistical analysis software is Statistics Analysis System (SAS) 9.3.

Conditions

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Aortic Dissection Aortic Arch Aneurysm Ulcer Pseudoaneurysm

Keywords

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Aortic Arch Endovascular Treatment Traditional Open Surgery Chimney Technique Fenestration Technique Branched Stent-grafts Technique

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Endovascular Aortic Repair

Patients with aortic arch lesions who only received endovascular treatment, including chimney / fenestration / branch stent-grafts technique and combination of these techniques, would be assigned to this group.

Endovascular Aortic Repair

Intervention Type PROCEDURE

Without surgery to expose the lesion directly, minimal invasive treatment for the aortic arch lesion under the guidance of imaging equipment is performed through the blood vessel with a tiny wound of a few centimeters, in our research, including chimney, branch stent-grafts and fenestration techniques.

Total Arch Replacement

Patients with aortic arch lesions who only received traditional open surgery for total aortic arch replacement, would be assigned to this group.

Total Arch Replacement

Intervention Type PROCEDURE

A kind of open surgery is performed for the replacement of total aortic arch.

Interventions

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Endovascular Aortic Repair

Without surgery to expose the lesion directly, minimal invasive treatment for the aortic arch lesion under the guidance of imaging equipment is performed through the blood vessel with a tiny wound of a few centimeters, in our research, including chimney, branch stent-grafts and fenestration techniques.

Intervention Type PROCEDURE

Total Arch Replacement

A kind of open surgery is performed for the replacement of total aortic arch.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients have aortic arch lesions caused by atherosclerosis and hypertension, and are also suitable for both chimney/ fenestration / branch stent-grafts technique and total arch replacement surgery simultaneously.
* Lesions involve the aortic arch, at least one branch of the aortic arch to be revascularized.
* The type of lesion is dissection, aneurysm, pseudoaneurysm, or ulcer.
* Life expectancy is more than 1 year.
* Patients are able to understand the purpose of this trial, voluntarily attend and sign the informed consent form, and are willing to accept the specified follow-up at specific time point.

Exclusion Criteria

* Patients had a stroke or ST-segment elevation myocardial infarction within 30 days prior to surgery.
* Patients underwent major surgery (grade 3 or above) or interventional therapy within 30 days prior to surgery.
* Patients will undergo any major elective surgery (grade 3 or above) or interventional therapy within 30 days after surgery.
* Patients had a previous thoracic aortic surgery in the past.
* Patients had previous thoracic aortic endovascular treatment, and the last implants had an effect on this procedure or had intersections with implants would be used in this procedure.
* Patients need intervention in other vascular lesions (such as coronary arteries, lower extremity arteries, carotid arteries) in the same procedure, or have heart disease and postoperative medication regimens are affected.
* Patients have hepatic and renal insufficiency (serum creatinine\> 186umol / L, Child-Pugh grade B, grade C).
* Aortic arch lesions are not caused by atherosclerosis or hypertension, such as connective tissue disease, aortic genetic diseases, etc.
* Aortic arch lesions are caused by Infectious diseases.
* Patients had serious illnesses (eg, severe chronic obstructive pulmonary disease (COPD) , cancer, dementia, etc.), or the physical condition would affect patients' compliance in this study.
* Patients are currently participating in other studies, and the primary endpoint has not been reached.
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Peking University People's Hospital

OTHER

Sponsor Role collaborator

China-Japan Friendship Hospital

OTHER

Sponsor Role collaborator

Beijing Hospital

OTHER_GOV

Sponsor Role collaborator

Chinese Academy of Medical Sciences, Fuwai Hospital

OTHER

Sponsor Role lead

Responsible Party

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Chang Shu

Director of Vascular Surgery Center

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chang Shu, Director

Role: PRINCIPAL_INVESTIGATOR

Chinese Academy of Medical Sciences, Fuwai Hospital

Locations

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Beijing Hospital

Beijing, Beijing Municipality, China

Site Status NOT_YET_RECRUITING

Chian-Japan Friendship Hospital

Beijing, Beijing Municipality, China

Site Status NOT_YET_RECRUITING

Chinese Academy of Medical Sciences, Fuwai Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

Peking University People's Hospital

Beijing, Beijing Municipality, China

Site Status NOT_YET_RECRUITING

Countries

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China

Central Contacts

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Mingyao Luo, Physician

Role: CONTACT

Phone: +86 17701022238

Email: [email protected]

Kun Fang, Physician

Role: CONTACT

Phone: +86 15201120100

Email: [email protected]

Facility Contacts

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Qian Zhou

Role: primary

Yong Cui

Role: primary

Enhua Cao

Role: primary

Tao Xu

Role: primary

Other Identifiers

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D171100002917004

Identifier Type: -

Identifier Source: org_study_id