COronary Re-engageMent aFter randOm NavitoR alignmenT (COMFORT STUDY)

NCT ID: NCT05779787

Last Updated: 2024-03-21

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 100 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2023-02-15
• Study Completion Date: 2027-05-15

Brief Summary

Whereas PCI before TAVR was previously recommended despite its uncertain prognostic role, recent data underline the possibility of a postponed coronary intervention using a commissural alignment technique. This approach allows easy coronary re-engagement through the valve stent frame with a trade off paid of procedure complexity.

Considering the prevalence of coronary artery disease (CAD) and the increasing percentage of younger patients treated with TAVI, investigate whether a simpler procedure with random implantation of Navitor valve is not inferior in terms of coronary re-access, is required The key point of the project will be the evaluation of the feasibility of coronary re-engagement after a Navitor valve randomly implanted.

Detailed Description

Transcatheter Aortic Valve Implantation (TAVI) is recommended by European and American guidelines to treat patients with aortic stenosis regardless of procedural risk (1, 2). In the last decades the increasing percentage of younger patients treated with TAVI, reflect the extensive indications in lower risk setting, highlighting the importance of easy coronary re-engagement after valve implantation. Considering the prevalence and the progression of a pre-existing coronary artery disease (CAD), the timing of coronary intervention should be accurate selected (3) addressing the percentage of unplanned percutaneous coronary intervention (PCI) after TAVI (4). In fact, while PCI before TAVR was previously recommend despite the uncertain prognostic role (5), recent data remarks the possibility of a postponed coronary intervention using a commissural alignment technique (6) that allows a predictable stent frame position in the sinus of Valsalva (7). Moreover, following the emerging concept of easy re-access, only a few types of prostheses have been shown to have an high degree of stent position predictability after implantation, leading to a limited option in terms of prosthesis choice. Furthermore, to achieve the best results with commissural alignment technique, accurate procedure planning and operator's expertise are required in order to properly manage the valve specific orientation in the aorta with consequent increase in time, radiation and procedure complexity.

However, geometry of the stent frame (height and size) and the anatomical characteristics of patients have to be enlisted as contributory factors to difficult coronary re-engagement and need to be evaluate in order to establish the feasibility of the re-access after TAVR.

The investigators' findings could provide data regarding the non-inferiority rate of coronary cannulation after a simpler procedure with Navitor implantation without alignment technique. Due to these results, the valves portfolio available in patients with coronary artery disease that needed PCI after TAVR, could be larger and various allowing the best protheses choice according to the patient's anatomy and operator's expertise. Finally, knowing the predictors of difficult re-engagement for both types of valves, regardless of implantation technique, could be interesting for an even more valve tailored approach.

The purpose of this study is to investigate the feasibility of coronary re-engagement after randomly (not aligned) Navitor implantation, as already perform in current clinical practice, due to a lower predictable orientation of this type of valve.

Conditions

Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

TAVR performed with commissural alignment technique (Aligned Group)

Patients with severe aortic stenosis undergoing TAVR procedure performed with commissural alignment technique. We consider in this groups only the Accurate and Accurate Neo 2 Valve which are the first choice due to the best stent frames position predictability with this technique

TAVR Aligned

Intervention Type: PROCEDURE

Investigate the feasibility of coronary re-engagement after commissural alignment technique in terms of success rate (%) and procedure complexity taking into account radiations, time and contrast used.

TAVR Random

Intervention Type: PROCEDURE

TAVR Random Feasibility comparison of coronary re-engagement between the randomly implanted Navitor valve (unaligned) and the others implanted with the commissural alignment technique in terms of success rate (%) and complexity of the procedure, taking into account radiation, time and contrast used

TAVR performed with random implantation of Navitor valve (Random Group)

Patients with severe aortic stenosis undergoing TAVR procedure performed with random implantation of Navitor Valve

TAVR Aligned

Intervention Type: PROCEDURE

Investigate the feasibility of coronary re-engagement after commissural alignment technique in terms of success rate (%) and procedure complexity taking into account radiations, time and contrast used.

TAVR Random

Intervention Type: PROCEDURE

TAVR Random Feasibility comparison of coronary re-engagement between the randomly implanted Navitor valve (unaligned) and the others implanted with the commissural alignment technique in terms of success rate (%) and complexity of the procedure, taking into account radiation, time and contrast used

Interventions

TAVR Aligned

Investigate the feasibility of coronary re-engagement after commissural alignment technique in terms of success rate (%) and procedure complexity taking into account radiations, time and contrast used.

Intervention Type: PROCEDURE

TAVR Random

TAVR Random Feasibility comparison of coronary re-engagement between the randomly implanted Navitor valve (unaligned) and the others implanted with the commissural alignment technique in terms of success rate (%) and complexity of the procedure, taking into account radiation, time and contrast used

Intervention Type: PROCEDURE

Eligibility Criteria

Exclusion Criteria

Patients excluded in this registry should have all the following criteria:

1. Valve in Valve procedure

2. Hemodynamical instability

3. TAVR performed from other access (not femoral)

4. No-CT Planned TAVR

5. TAVR performed with Chimney Technique

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Niguarda Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

ASST GOM Niguarda

Milan, Lombardy, Italy

Site Status: RECRUITING

Countries

Italy

Central Contacts

Giuseooe Esposito, MD

Role: CONTACT

giuseppe.esposito@yahoo.com

+393278393131

Facility Contacts

Giuseppe Esposito, MD

Role: primary

giuseppe.esposito@yahoo.com

+393278393131

Other Identifiers

D001024

Identifier Type: -

Identifier Source: org_study_id