Edge-to-edge Mitral Valve Repair in ATTR-CM

NCT ID: NCT06075823

Last Updated: 2023-12-11

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-01

Study Completion Date

2028-12-12

Brief Summary

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No previous study has evaluated the effectiveness of transcatheter edge-to-edge mitral valve repair (TEER) in patients with ATTR-associated cardiomyopathy (ATTR-CM) and significant mitral regurgitation, as this specific patient population was specifically excluded from previous large TEER trials. From a pathophysiological perspective, effective treatment of significant regurgitant volume and consecutive improvement of forward volume appears highly desirable in a condition with intrinsically low output. However, whether this translates into improved functional capacity, better quality of life, and better clinical outcomes compared to conservative heart failure management alone remains to be investigated.

Detailed Description

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It is the aim of this trial to investigate the effectiveness of TEER therapy in patients with proven ATTR-CM and concomitant significant MR as compared to medical therapy alone. Effectiveness will be tested via hard clinical outcomes, biomarkers, functional capacity, and quality of life.

Conditions

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Mitral Regurgitation ATTR-Cardiomyopathy Edge-to-Edge Mitral Valve Repair

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Interventional

TEER + Optimal Medical Therapy

Group Type EXPERIMENTAL

TEER

Intervention Type DEVICE

transcatheter edge-to-edge mitral valve repair for significant mitral regurgitation

Optimal Medical Therapy

Intervention Type OTHER

optimal heart failure management of ATTR-CM

Control

Optimal Medical Therapy alone

Group Type ACTIVE_COMPARATOR

Optimal Medical Therapy

Intervention Type OTHER

optimal heart failure management of ATTR-CM

Interventions

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TEER

transcatheter edge-to-edge mitral valve repair for significant mitral regurgitation

Intervention Type DEVICE

Optimal Medical Therapy

optimal heart failure management of ATTR-CM

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Proven ATTR-CM
* Significant symptomatic MR (3+ or 4+ by independent echocardiographic core laboratory assessment)
* Subject has been adequately treated per applicable standards, including for coronary artery disease and heart failure (e.g., diuretics)
* New York Heart Association (NYHA) functional class II, III, or ambulatory IV
* Local heart team has determined that mitral valve surgery will not be offered as a treatment option, even if the subject is randomized to the control group
* Left ventricular ejection fraction ≥20%
* Anatomical feasibility for TEER as per discretion of the implanting investigator
* Age 18 years or older
* Subject or guardian agrees to all provisions of the protocol, including the possibility of randomization to the Control group and returning for all required post-procedure follow-up visits, and has provided written informed consent

Exclusion Criteria

* AL-associated cardiomyopathy
* Aortic or tricuspid valve disease requiring surgery or transcatheter intervention
* Severe right ventricular dysfunction
* Hemodynamic instability requiring inotropic support or mechanical heart assistance
* Leaflet anatomy which may preclude TEER, proper device positioning on the leaflets or sufficient reduction in mitral regurgitation by TEER
* Life expectancy \<12 months due to non-cardiac conditions
* Prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve, or any prior transcatheter mitral valve procedure
* Echocardiographic evidence of intracardiac mass, thrombus or vegetation
* Active endocarditis or active rheumatic heart disease or leaflets degenerated from rheumatic disease (i.e., noncompliant, perforated)
* Active infections requiring current antibiotic therapy
* Transesophageal echocardiography (TEE) is contraindicated or high risk
* Pregnant or planning pregnancy within next 12 months
* Currently participating in another investigational device study that has not reached its primary endpoint
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Vienna

OTHER

Sponsor Role lead

Responsible Party

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Christian Nitsche

Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christian Nitsche, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Medical University of Vienna

Central Contacts

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Christian Nitsche, MD, PhD

Role: CONTACT

Phone: 0043 1 40400 46142

Email: [email protected]

References

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Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ; COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018 Dec 13;379(24):2307-2318. doi: 10.1056/NEJMoa1806640. Epub 2018 Sep 23.

Reference Type BACKGROUND
PMID: 30280640 (View on PubMed)

Dona C, Nitsche C, Koschutnik M, Heitzinger G, Mascherbauer K, Kammerlander AA, Dannenberg V, Halavina K, Rettl R, Duca F, Traub-Weidinger T, Puchinger J, Gunacker PC, Lamm G, Vock P, Lileg B, Philipp V, Staudenherz A, Calabretta R, Hacker M, Agis H, Bartko P, Hengstenberg C, Fontana M, Goliasch G, Mascherbauer J. Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair. JACC Cardiovasc Interv. 2022 Sep 12;15(17):1748-1758. doi: 10.1016/j.jcin.2022.06.009. Epub 2022 Aug 22.

Reference Type RESULT
PMID: 36008266 (View on PubMed)

Chacko L, Karia N, Venneri L, Bandera F, Passo BD, Buonamici L, Lazari J, Ioannou A, Porcari A, Patel R, Razvi Y, Brown J, Knight D, Martinez-Naharro A, Whelan C, Quarta CC, Manisty C, Moon J, Rowczenio D, Gilbertson JA, Lachmann H, Wechelakar A, Petrie A, Moody WE, Steeds RP, Potena L, Riefolo M, Leone O, Rapezzi C, Hawkins PN, Gillmore JD, Fontana M. Progression of echocardiographic parameters and prognosis in transthyretin cardiac amyloidosis. Eur J Heart Fail. 2022 Sep;24(9):1700-1712. doi: 10.1002/ejhf.2606. Epub 2022 Jul 27.

Reference Type RESULT
PMID: 35779241 (View on PubMed)

Nitsche C. Echocardiographic tracking of transthyretin cardiomyopathy: which parameters matter the most? Eur J Heart Fail. 2022 Sep;24(9):1713-1715. doi: 10.1002/ejhf.2639. Epub 2022 Aug 12. No abstract available.

Reference Type RESULT
PMID: 35906799 (View on PubMed)

Other Identifiers

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1830/2023

Identifier Type: -

Identifier Source: org_study_id