Carmat Total Artificial Heart as a Bridge to Transplant in Patients With Advanced Heart Failure

Advanced Heart Failure Clinical Trial

— EFICAS  

Official title:

Multicentric Prospective Cohort Study in Patients With Irreversible Biventricular Heart Failure to Assess the Efficacy and Safety of Carmat TAH, Its Clinical Utility and Cost, as a Bridge to Transplantation

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04475393
• Other study ID #: CAR2019-FR
• Status: Recruiting
• Phase: N/A
• Start date: December 12, 2022
• Est. completion date: April 2027

Study information

• Verified date: January 2024
• Source: Carmat SA
• Contact: Soumia Aoualli
• Phone: +33 63 826 5953
• Email: clinique[@]carmatsas.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The objective of this clinical investigation is to evaluate the efficacy and the safety of the Carmat Total Artificial Heart for the treatment of refractory advanced heart failure in transplant eligible patients.

Description:

A selection committee (composed of two independent experts in the field of cardiovascular surgery/cardiology and of PIs) assess the subject eligibility based on clinical and anatomic criteria. Clinically eligible patients will be distributed into two cohorts depending on their anatomic compatibility with the device:

• cohort 1: patients that are anatomically compatible will receive the Carmat TAH ;

• cohort 2: patients that are not anatomically compatible will receive standard therapy

The efficacy and safety of the Carmat TAH will be assessed in cohort 1 and compared to a level of efficacy defined by the published data on the commercially available TAH; and adjusted for INTERMACS patient profile.

The clinical utility and the costs of Carmat TAH will be assessed by comparing the cohort of subject receiving the Carmat TAH to the cohort of patients treated by standard therapy

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 52
• Est. completion date: April 2027
• Est. primary completion date: April 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Patient 18 years or older

2. Patient in the waiting list for heart transplant or temporarily contraindicated for heart transplant

3. Inotrope dependent* or cardiac Index (CI) < 2.2 L/min/m2 if inotropes are contra-indicated (heart failure due to restrictive or constrictive physiology).

• Inotrope dependence needs to be confirmed by failed weaning or justified in medical records.

4. On Optimal Medical Management as judged by the investigator based on current Heart Failure practice guidelines (ESC/HAS)

5. Eligible to biventricular Mechanical Circulatory Support according to one of the following category:

1. Biventricular failure with at least two of the following hemodynamic/ echocardiographic measurements implying right heart failure:

• RVEF = 30%

• RVSWI = 0.25 mmHg*L/m2

• TAPSE = 14mm

• RV-to-LV end-diastolic diameter ratio > 0.72

• CVP > 15 mmHg

• CVP-to-PCWP ratio > 0.63

• PAP index <2

• Tricuspid insufficiency grade 4

2. Treatment-refractory recurrent and sustained ventricular tachycardia or ventricular fibrillation in the presence of untreatable arrhythmogenic pathologic substrate.

3. Heart failure due to restrictive or constrictive physiology (e.g., hypertrophic cardiomyopathy, cardiac amyloidosis / senile or other infiltrative heart disease)

6. Anatomic compatibility confirmed using 3D imaging (CT-scan) and by the screening committee (for Cohort 1).

7. Patient's affiliation to health care insurance

8. Patient has signed the informed consent.

Exclusion Criteria:

1. Absolute contra-indication for heart transplant

2. Existence of any ongoing non-temporary mechanical circulatory support

3. Existence of any ongoing peripheral mechanical circulatory support such as ECMO, Impella (all types), IABP with a support duration > 21 days

4. Patient intubated and unconscious; or intubated and not awake

5. Known intolerance to anticoagulant or antiplatelet therapies or known Heparin Induced Thrombocytopenia.

6. Coagulopathy defined by platelets < 100G/l or INR = 1.5 not due to anticoagulant therapy.

7. Known thrombophilia (Antithrombin III, protein C or S deficiency) or any recurrent venous thromboembolic events requiring long term curative oral anticoagulation.

8. Cerebrovascular accident < 3 months or symptomatic (Rankin score >1; Glasgow score < 14) or a known > 80% carotid stenosis.

9. Known abdominal or thoracic aortic aneurysm > 5 cm that has not been treated.

10. Severe end-organ dysfunction as per the following criteria:

1. Total bilirubin > 45 µmol/l (2.65 mg/dl) or cirrhosis evidenced by ultrasound, IRM and positive biopsy

2. GFR < 40ml/min/1.73m2 (with no hemodialysis)

11. History of severe Chronic Obstructive Pulmonary Disease or severe restrictive lung disease with FEV1/FVC <0.7 and FEV1<50% predicted.

12. Recent active blood stream infection confirmed by a positive hemoculture within 48 hours.

13. Documented amyloid light-chain (AL amyloidosis).

14. Hemodynamically significant peripheral vascular disease assessed by clinical exam.

15. Illness, other than heart disease, that would limit survival to less than 2 years.

16. Irreversible cognitive dysfunction, psycho-cognitive disabilities, psycho-social issues or psychiatric disease, likely to impair compliance with the study protocol and TAH management that in the opinion of the investigator could interfere with the ability to manage the therapy (i.e. non-compliance to heart failure therapy, uncontrolled diabetes, mental health issue, etc.).

17. Pregnancy or breast feeding (woman in childbearing age will have to show negative pregnancy test).

18. Patient is currently enrolled or has participated in the last 30 days in another therapeutic or interventional clinical study that is likely to confound the study results or affect the study.

Related Conditions & MeSH terms

• Advanced Heart Failure
• Heart Failure

Intervention

Device:
• Carmat Total Artificial Heart
Heart Replacement Therapy

Locations

Country	Name	City	State
France	Hôpital Louis Pradel	Bron
France	CHU Dijon	Dijon
France	Hôpital Marie Lannelongue	Le Plessis-Robinson
France	Centre Hospitalier Régional Universitaire	Lille
France	CHRU Montpellier	Montpellier
France	Groupe Hospitalier Pitié-Salpêtrière,	Paris
France	Hôpital Européen George Pompidou	Paris
France	Hôpital Pontchaillou	Rennes
France	Nouvel Hôpital Civil	Strasbourg

Sponsors (1)

Lead Sponsor	Collaborator
Carmat SA

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Survival free of disabling stroke at 180 days post-implant	Success is defined as survival free of disabling stroke (Modified Rankin score >3) at 180 days after Carmat TAH; implantation or transplanted if before 180 days.	180 days
Secondary	Overall survival	Survival post-implant; Survival post-transplantation (Kaplan-Meier)	180 days - 1 year
Secondary	General Health Status change	Measured with the EuroQol EQ-5D-5L questionnaire, health-related quality of life consisting of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each of which can take one of five responses (EQ-5D-5L). The responses record five levels of severity (1:no problems; 2:slight problems; 3:moderate problems 4:severe problems; 5:extreme problems) within a particular EQ-5D dimension.	180 days - 1 and 2 years
Secondary	Change in functional status measured by the Six Minutes Walk Test	The 6-min walk test is a submaximal exercise test that entails measurement of distance walked over a span of 6 minutes. The 6-minute walk distance provides a measure for integrated global response of multiple cardiopulmonary and musculoskeletal systems involved in exercise.	180 days - 1 and 2 years
Secondary	Change in functional status	New York Heart Association (NYHA) functional classification (regression scale I, II, III, IV)	180 days - 1 and 2 years
Secondary	Adverse Events	Adverse Event Rates will be captured per the INTERMACS definitions	180 days - 1 and 2 years
Secondary	Hospital re-admissions rate	Rate of unplanned re-admissions to the hospital	180 days - 1 and 2 years
Secondary	Healthcare costs	The healthcare resources used to treat the patient during the two-year period, including those related to selection, those related to waiting for transplantation (whatever the therapeutic strategy), to transplantation, post-transplant management and any adverse event	180 days - 1 and 2 years
Secondary	Quality Adjusted Life Years	The Quality Adjusted Life Years, evaluated during the two-year period, values the health outcomes in a single measure by combining both quality of life (evaluated by EuroQol EQ-5D-5L) and lenght of life.	180 days - 1 and 2 years