HANGZHOU Solution in Bicuspid AS Undergoing TAVR

NCT ID: NCT04722796

Last Updated: 2021-06-02

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

RECRUITING

Clinical Phase

NA

Total Enrollment

508 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-12

Study Completion Date

2028-04-01

Brief Summary

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To compare supra-annular sizing and THV implantation technique (Hangzhou solution) versus annular sizing and THV implantation technique (control group) in bicuspid aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs): a randomized superiority trial

Detailed Description

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Transcatheter aortic valve replacement (TAVR) has emerged as a favorable alternative for severe symptomatic aortic stenosis (AS) patients from low to high surgical risk. BAV patients treated with TAVR had similar 30-day mortality as well as stroke and new pacemaker implantation rates compared to TAV subjects, but carried higher risk of moderate/severe PVL, conversion to surgery and device failure. Event rates significantly decreased with the use of new-generation devices, but TAVR still showed better procedural results in TAV compared to BAV.

Clinical experience in China suggests bicuspid aortic valves and heavy calcium burden are more common among TAVR candidates. Morphological characteristics at supra-annular structure (from annulus to the level of sinotubular junction) are quite complex in bicuspid AS, especially concomitant with heavily calcified leaflets. Because only two leaflet hinge points provide the definition of the annulus plane, current CT-based annulus measurements might not be accurate under these circumstances. From previous single center clinical practice, "waist sign" above the annulus during balloon aortic valvuloplasty in TAVR was often observed in patients with bicuspid AS, indicating that the supra-annular structure may serve a key role in anchoring the THV.

Therefore, we developed a balloon based supra-annular sizing strategy (Hangzhou Solution) for SEV implantation in bicuspid AS. From our single center experience, the device success rate and pacemaker implantation rate were relatively low.

The aim of this study is to compare supra-annular sizing and THV implantation technique (Hangzhou solution) versus annular sizing and THV implantation technique (control group) in bicuspid aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs).

Conditions

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Aortic Stenosis Aortic Stenosis With Bicuspid Valve

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The participants and ourcome assessor are blind to treatment groups.

Study Groups

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TAVR with Supra-annular sizing strategy

Experimental: Supra-annular sizing strategy (Hangzhou Solution).

Pre-dilation with balloon size (20/23/26mm Z-MED) just below the annular size.

Waist sign with less than mild contrast regurgitation: Venus A plus Valve down size and Target implant depth 0-2mm.

No waist sign and/or contrast regurgitation or unable to finish supra-annular sizing: annular sizing Venus A plus Valve with implant depth 4-6mm.

Group Type EXPERIMENTAL

TAVR with Venus A plus using supra-annular sizing and THV implantation technique (Hangzhou solution)

Intervention Type DEVICE

Transcatheter aortic valve replacement (TAVR) with Venus A plus using supra-annular sizing and THV implantation technique (Hangzhou solution)

TAVR with Annulus based sizing strategy

Control: Traditional sizing strategy (Annulus based sizing strategy).

Pre-dilation with balloon size (20/23/26mm Z-MED) just below the annular size.

Annular sizing Venus A plus Valve with implant depth 4-6mm.

Group Type OTHER

TAVR with Venus A plus using annular sizing and THV implantation technique

Intervention Type DEVICE

Transcatheter aortic valve replacement (TAVR) with Venus A plus using annular sizing and THV implantation technique (Traditional sizing strategy)

Interventions

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TAVR with Venus A plus using supra-annular sizing and THV implantation technique (Hangzhou solution)

Transcatheter aortic valve replacement (TAVR) with Venus A plus using supra-annular sizing and THV implantation technique (Hangzhou solution)

Intervention Type DEVICE

TAVR with Venus A plus using annular sizing and THV implantation technique

Transcatheter aortic valve replacement (TAVR) with Venus A plus using annular sizing and THV implantation technique (Traditional sizing strategy)

Intervention Type DEVICE

Other Intervention Names

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Hangzhou solution Traditional sizing strategy (Annulus based sizing strategy)

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 65 years
* Age \<65 years and age ≥ 60 years with high surgical risk after combing STS Risk Estimate, Katz activities of Daily Living, major Organ System Dysfunction and Procedure-Specific Impediment;
* Severe, bicuspid aortic stenosis:
* Mean gradient ≥40 mmHg
* Maximal aortic valve velocity ≥4.0 m/sec
* Aortic valve area ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2)
* NYHA classification ≥ II;
* Type 0, type 1 (Sievers classification) by MDCT
* Perimeter-derived annulus diameter ranges from 20.0 mm to 29.0 mm;
* Transfemoral TAVR
* The study patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent as approved by the Institutional Review Board (IRB)/Ethics Committee (EC) of the respective clinical site.

Exclusion Criteria

* Any contra-indication for Self-expanding bioprosthetic aortic valve deployment
* Leukopenia (WBC \< 3000 cell/mL), acute anemia (Hgb \< 9 g/dL), Thrombocytopenia (Plt\< 50,000 cell/mL).
* Active sepsis, including active bacterial endocarditis with or without treatment;
* Evidence of an acute myocardial infarction ≤ 1 month (30 days) before the intended treatment \[(defined as: Q wave MI, or non-Q wave MI with total CK elevation of CK-MB ≥ twice normal in the presence of MB elevation and/or troponin level elevation (WHO definition)\].
* Stroke or transient ischemic attack (TIA) within 3 months (90 days) of the procedure.
* Estimated life expectancy \< 12 months (365 days) due to carcinomas, chronic liver disease, chronic renal disease or chronic end stage pulmonary disease.
* Any Emergent surgery required before TAVR procedure.
* A known hypersensitivity or contraindication to any of the following that cannot be adequately medicated:aspirin or heparin (HIT/HITTS) and bivalirudin, clopidogrel,Nitinol (titanium or nickel),contrast media
* Gastrointestinal (GI) bleeding that would preclude anticoagulation.
* Subject refuses a blood transfusion.
* Severe dementia (resulting in either inability to provide informed consent for the study/procedure, prevents independent lifestyle outside of a chronic care facility, or will fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits).
* Other medical, social, or psychological conditions that in the opinion of the investigator precludes the subject from appropriate consent or adherence to the protocol required follow-up exams.
* Currently participating in an investigational drug or another device study (excluding registries).
* Hypertrophic cardiomyopathy (HCM with myocardium more than 1.5cm without an identifiable cause) with obstruction (HOCM).
* Echocardiographic evidence of intracardiac mass, thrombus or vegetation.
* Severe mitral stenosis amenable to surgical replacement or repair.
* Aortic valve type cannot be determined (Sievers classification).
* Significant aortic disease, including marked tortuosity (hyperacute bend), aortic arch atheroma \[especially if thick (\> 5 mm), protruding or ulcerated\] or narrowing (especially with calcification and surface irregularities) of the abdominal or thoracic aorta, severe"unfolding" and horizontal aorta(Annular Angulation\>70°).
* Ascending aorta diameter \> 50 mm.
* Aortic or iliofemoral vessel characteristics that would preclude safe placement of the introducer sheath.
* Patient is considered high risk for TAVR by CT corelab, including coronary obstruction, annular rupture and other severe TAVR-Related complications.
* Previous pacemaker implantation.
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Venus MedTech (HangZhou) Inc.

INDUSTRY

Sponsor Role collaborator

The First Affiliated Hospital of Bengbu Medical University

OTHER

Sponsor Role collaborator

Chinese PLA General Hospital

OTHER

Sponsor Role collaborator

Fujian Medical University Union Hospital

OTHER

Sponsor Role collaborator

Xiamen University Affiliated Cardiovascular Hospital

UNKNOWN

Sponsor Role collaborator

The Second People's Hospital of GuangDong Province

OTHER

Sponsor Role collaborator

Chinese Academy of Medical Sciences, Fuwai Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Zhengzhou University

OTHER

Sponsor Role collaborator

Henan Provincial Chest Hospital

OTHER

Sponsor Role collaborator

Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

OTHER

Sponsor Role collaborator

Central South University

OTHER

Sponsor Role collaborator

Northern Jiangsu People's Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Nanchang University

OTHER

Sponsor Role collaborator

Second Affiliated Hospital of Nanchang University

OTHER

Sponsor Role collaborator

The Affiliated Hospital of Qingdao University

OTHER

Sponsor Role collaborator

Shanxi Cardiovascular Hospital

OTHER

Sponsor Role collaborator

Tianjin Chest Hospital

OTHER

Sponsor Role collaborator

Ning Bo First Hospital

UNKNOWN

Sponsor Role collaborator

Second Affiliated Hospital, School of Medicine, Zhejiang University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jian'an Wang, PhD, MD

Role: STUDY_CHAIR

2nd Affiliated Hospital, School of Medicine, Zhejiang University, China

Locations

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The First affiliated hospital of bengbu medical college

Bengbu, Anhui, China

Site Status NOT_YET_RECRUITING

The General Hospital of the People's Liberation Army

Beijing, Beijing Municipality, China

Site Status NOT_YET_RECRUITING

Fujian Medical University Union Hospital

Fuzhou, Fujian, China

Site Status NOT_YET_RECRUITING

Xiamen University Affiliated Cardiovascular Hospital

Xiamen, Fujian, China

Site Status NOT_YET_RECRUITING

Guangdong People's Hospital

Guangzhou, Guangdong, China

Site Status NOT_YET_RECRUITING

Zhengzhou Cardiovascular Hospital

Zhengzhou, Henan, China

Site Status NOT_YET_RECRUITING

The First Affiliated Hospital of Zhengzhou University

Zhengzhou, Henan, China

Site Status NOT_YET_RECRUITING

Hennan Provincial Chest Hospital

Zhengzhou, Hennan, China

Site Status NOT_YET_RECRUITING

Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology

Wuhan, Hubei, China

Site Status RECRUITING

The Second XIANGYA Hospital Of Central South University

Changsha, Hunan, China

Site Status NOT_YET_RECRUITING

Northern Jiangsu People's Hospital

Yangzhou, Jiangsu, China

Site Status NOT_YET_RECRUITING

The First Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status NOT_YET_RECRUITING

The Second Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status NOT_YET_RECRUITING

The Affiliated Hospital of Qingdao University

Qingdao, Shandong, China

Site Status NOT_YET_RECRUITING

Shanxi Cardiovascular Hospital

Taiyuan, Shanxi, China

Site Status NOT_YET_RECRUITING

tianjin Chest Hospital

Tianjing, Tianjing, China

Site Status NOT_YET_RECRUITING

The Second Affiliated Hospital Zhejiang University School of Medicine.

Hangzhou, Zhejiang, China

Site Status RECRUITING

Ning Bo First Hospital

Ningbo, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Jian'an Wang, PhD, MD

Role: CONTACT

+86057187783777

Facility Contacts

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Shili Wu

Role: primary

Yundai Chen

Role: primary

Lianglong Cheng

Role: primary

Yan Wang

Role: primary

Jianfang Luo

Role: primary

Shenwei Zhang

Role: primary

Jianzeng Dong

Role: primary

Yiqiang Yuan

Role: primary

Xiaoke Shang

Role: primary

Zhengfei Fang

Role: primary

Shenghu He

Role: primary

Xiaoping Peng

Role: primary

Yanqing Wu

Role: primary

Lei Jiang

Role: primary

Jian An

Role: primary

Nan Jiang

Role: primary

Jian'an Wang, MD

Role: primary

Xiaomin Cheng

Role: primary

Other Identifiers

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2021-0007

Identifier Type: -

Identifier Source: org_study_id

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