Validation of Accurate Commissural Alignment During Transcatheter Aortic Valve Implantation

NCT ID: NCT05097183

Last Updated: 2022-04-20

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

274 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-12-01

Study Completion Date

2024-12-31

Brief Summary

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Background: Transcatheter aortic valve replacement (TAVR) has become the preferred therapy for aortic stenosis. Given the growing life-expectancy, the risk of requiring coronary interventions or of developing prosthesis degeneration that could require TAVR-in-TAVR for its treatment progressively increases. During standard TAVI procedures the native and the prosthesis commissures are randomly aligned with misalignment in up to 70% of the cases. This might hinder coronary re-access in 18% of the cases, increase the risk of coronary obstruction during future TAVR-in-TAVR procedures, and has been associated to greater residual gradients.

Methods: Although several techniques have been developed to increase the degree of commissural alignment, all are imperfect or imply manipulation of the system within the patient, potentially increasing the risk of complications. The research team developed a software based on computed tomography analysis that allows planification of accurate commissural alignment by inserting the delivery system in a patient-specific degree of rotation.

Aim: The proponent team aimed to prospectively validate this methodology comparing a cohort of patients harboring TAVR with Acurate Commissural Alignment (ACA) vs. a control cohort with non-ACA standard technique, in order to determine benefits in terms of coronary re-access and clinical events (coronary events, valve degeneration, and TAVR-in-TAVR).

Detailed Description

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Conditions

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Severe Aortic Valve Stenosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Control

Transcatheter aortic valve replacement (TAVR) with standard procedure

No interventions assigned to this group

ACA

Transcatheter aortic valve replacement (TAVR) with Accurate Commissural Alignment (ACA) technique

Accurate Commissural Alignment (ACA)

Intervention Type PROCEDURE

Software based, computed tomography analysis that allows planification of accurate commissural alignment of TAVR by inserting the delivery system in a patient-specific degree of rotation.

Interventions

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Accurate Commissural Alignment (ACA)

Software based, computed tomography analysis that allows planification of accurate commissural alignment of TAVR by inserting the delivery system in a patient-specific degree of rotation.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients diagnosed with severe aortic stenosis admitted to TAVR by Heart Team
* Pre-procedure CT-Scan for planning available.
* Signed informed consent.

Exclusion Criteria

* Allergic to contrast
* Severe renal failure (GFR \< 30 mL/min)
* Indication for chronic anticoagulation
* Horizontal aorta and/or severe aortic tortuosity
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Gerencia Regional de Salud de Castilla y Leon

OTHER

Sponsor Role collaborator

Ignacio J. Amat Santos

OTHER

Sponsor Role lead

Responsible Party

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Ignacio J. Amat Santos

Coordinator of Interventional Cardiology Unit

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Complejo Hospitalario Universitario A Coruña

A Coruña, , Spain

Site Status RECRUITING

Hospital Clinic, Barcelona

Barcelona, , Spain

Site Status RECRUITING

Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Site Status RECRUITING

Hospital Universitario Reina Sofía

Córdoba, , Spain

Site Status NOT_YET_RECRUITING

Hospital Universitari Bellvitge

L'Hospitalet de Llobregat, , Spain

Site Status RECRUITING

Hospital clínico San Carlos

Madrid, , Spain

Site Status RECRUITING

Hospital La Paz

Madrid, , Spain

Site Status NOT_YET_RECRUITING

Hospital Universitario Ramón y Cajal

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario Virgen de la Victoria

Málaga, , Spain

Site Status NOT_YET_RECRUITING

Hospital Clínico Universitario Virgen de la Arrixaca

Murcia, , Spain

Site Status RECRUITING

Hospital Universitario Central de Asturias

Oviedo, , Spain

Site Status RECRUITING

Hospital Clínico Universitario de Salamanca

Salamanca, , Spain

Site Status RECRUITING

Hospital Clínico Universitario de Santiago

Santiago de Compostela, , Spain

Site Status RECRUITING

Hospital Virgen del Rocío

Seville, , Spain

Site Status NOT_YET_RECRUITING

Hospital Universitario Miguel Servet

Zaragoza, , Spain

Site Status NOT_YET_RECRUITING

Countries

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Spain

Central Contacts

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Ignacio J Amat-Santos, PhD

Role: CONTACT

983420000 ext. 86571

Carlos Baladrón, PhD

Role: CONTACT

983420000 ext. 86571

Facility Contacts

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Pablo Piñón

Role: primary

Ander Regueiro

Role: primary

Álvaro Calabuig

Role: primary

Manuel P Álvarez Ossorio

Role: primary

Joan A Gómez Hospital

Role: primary

Luis Nombela

Role: primary

Raúl Moreno

Role: primary

Ángel Sánchez Recalde

Role: primary

Antonio J. Muñoz

Role: primary

Eduardo Pinar

Role: primary

Raquel del Valle

Role: primary

Ignacio Cruz

Role: primary

Ramiro Trillo

Role: primary

José F Díaz

Role: primary

José A Diarte

Role: primary

References

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Redondo A, Valencia-Serrano F, Santos-Martinez S, Delgado-Arana JR, Barrero A, Serrador A, Gutierrez H, Sanchez-Lite I, Sevilla T, Revilla A, Baladron C, Kim WK, Carrasco-Moraleja M, San Roman JA, Amat-Santos IJ. Accurate commissural alignment during ACURATE neo TAVI procedure. Proof of concept. Rev Esp Cardiol (Engl Ed). 2022 Mar;75(3):203-212. doi: 10.1016/j.rec.2021.02.004. Epub 2021 Mar 26. English, Spanish.

Reference Type BACKGROUND
PMID: 33781722 (View on PubMed)

Redondo A, Santos-Martinez S, Delgado-Arana R, Baladron Zorita C, San Roman JA, Amat-Santos IJ. Fluoroscopic-based algorithm for commissural alignment assessment after transcatheter aortic valve implantation. Rev Esp Cardiol (Engl Ed). 2022 Feb;75(2):184-187. doi: 10.1016/j.rec.2021.08.010. Epub 2021 Sep 30. No abstract available. English, Spanish.

Reference Type BACKGROUND
PMID: 34600863 (View on PubMed)

Amat-Santos IJ, Gomez-Herrero J, Pinon P, Nombela-Franco L, Moreno R, Munoz-Garcia AJ, Redondo A, Gomez-Menchero A, Gomez-Salvador I, San Roman JA. Impact of commissural alignment on the hemodynamic performance of supra-annular self-expandable transcatheter aortic valves. Catheter Cardiovasc Interv. 2024 Nov;104(5):1060-1070. doi: 10.1002/ccd.31201. Epub 2024 Sep 10.

Reference Type DERIVED
PMID: 39252591 (View on PubMed)

Other Identifiers

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ICICOR-ACA-2021

Identifier Type: -

Identifier Source: org_study_id

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