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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT04722250
Other study ID # MDT20023EVR012
Secondary ID
Status Active, not recruiting
Phase N/A
First received
Last updated
Start date April 2, 2021
Est. completion date December 2027

Study information

Verified date April 2024
Source Medtronic Cardiovascular
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of this trial is to generate clinical evidence on valve safety and performance of self-expanding (SE) versus balloon-expandable (BE) transcatheter aortic valve replacement (TAVR) in subjects with a small aortic annulus and symptomatic severe native aortic stenosis. Additionally, a stress echocardiography sub-study will be conducted as part of the SMART Trial at select sites. The purpose of the sub-study is to evaluate performance of SE versus BE TAVR in subjects with a small aortic annulus and symptomatic severe native aortic stenosis after undergoing exercise stress echocardiographic testing.


Description:

This is a prospective, multi-center, international, randomized controlled, post-market trial. The primary objectives of the trial are to demonstrate clinical non-inferiority and hemodynamic superiority of the Evolut PRO/PRO+/FX System when compared to subjects treated with the SAPIEN 3/3 Ultra System at 12 months post-procedure. Subjects will be randomized on a 1:1 basis to receive TAVR with either a Medtronic SE Transcatheter Aortic Valve (TAV) or an Edwards BE Transcatheter Heart Valve (THV). Data will be collected at pre- and post-procedure, at discharge, at 30 days, and once a year until the 5-year follow-up is completed. Product Names: - Medtronic Evolut PRO and Evolut PRO+ TAV Systems, Evolut FX System (Commercially available in the United States and may be used upon commercial availability in Canada.) - Edwards SAPIEN 3 and SAPIEN 3 Ultra THV Systems The exercise stress echocardiographic testing at select SMART Trial sites seeks to evaluate the performance of the prosthetic aortic valve during exercise. The stress echocardiogram assessment will be conducted as part of the 12-month visit for participating subjects.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 716
Est. completion date December 2027
Est. primary completion date November 10, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Heart Team agrees that the subject is deemed symptomatic and is a candidate for transcatheter aortic valve replacement (TAVR) - Subject has a predicted risk of operative mortality < 15% as determined by the local Heart Team - Subject has severe aortic stenosis as determined by transthoracic echocardiography (TTE) at rest - Subject has a small aortic annulus as determined by Multi-detector computed tomography (MDCT) - Subject's anatomy is appropriate for both Medtronic Evolut PRO/PRO+/FX TAV and Edwards SAPIEN 3/3 Ultra TAV - Subject's anatomy is suitable for TAVR via transfemoral vessel access - Subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits Exclusion Criteria: - Estimated life expectancy of fewer than 2 years - Multivessel coronary artery disease with a Syntax score >32 and/or unprotected left main coronary artery(Syntax score calculation is not required for patients with history of previous revascularization if repeat revascularization is not planned). - Participating in another trial that may influence the outcome of this trial - Need for an emergent procedure for any reason - Contraindicated for treatment with the Evolut PRO/PRO+/FX and Edwards SAPIEN 3/3 Ultra TAV in accordance with the Instructions for Use - 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 - Pregnant, nursing, or planning to be pregnant - Subject is less than the legal age of consent, legally incompetent, unable to provide his/her own informed consent, or otherwise vulnerable - Subject has an active COVID-19 infection or relevant history of COVID-19 - Previous aortic valve replacement

Study Design


Intervention

Device:
Medtronic Evolut PRO, Evolut PRO+ or Evolut FX (where commercially available) TAV Systems
TAVR treatment with Medtronic Evolut PRO, PRO+ System or Evolut FX System (where commercially available)
Edwards SAPIEN 3 or SAPIEN 3 Ultra THV Systems
TAVR treatment with Edwards SAPIEN 3 or SAPIEN 3 Ultra System

Locations

Country Name City State
Canada Montreal Heart Institute Montréal Quebec
Canada St. Michaels Hospital/Unity Health Toronto Toronto Ontario
Canada Toronto General Hospital Toronto Ontario
Canada Providence Health-St. Paul's Hospital Vancouver British Columbia
Canada Victoria Heart Institute Foundation/Royal Jubilee Hospital Victoria British Columbia
Denmark Rigshospitalet Copenhagen
Finland Helsinki University Hospital Helsinki
France Centre Hospitalier Universitaire de Clermont-Ferrand Clermont-Ferrand
France CHU Bordeaux Pessac
France Clinique Pasteur Toulouse
Germany Hers-und Diabeteszentrum NRW - Ruhr -Universitati Bochum Bad Oeynhausen
Germany Deutsches Herzzentrum Berlin Berlin
Germany Kath. St.-Johannes-Gesellschaft Dortmund gGmbH - St. Johannes-Hospital Dortmund Dortmund
Germany Universitätsklinikum Düsseldorf Düsseldorf
Germany Universitätsklinikum Schleswig-Holstein - Campus Kiel Kiel
Germany Helios Health Institute GmbH Leipzig
Germany Universitätsklinikum Schleswig-Holstein - Campus Lübeck Lübeck
Germany Deutsches Herzzentrum Munchen München
Israel Sheba Medical Center Ramat Gan
Israel Tel Aviv Sourasky Medical Center Tel Aviv
Italy Policlinico Sant' Orsala - Malpighi Bologna
Italy Azienda Ospedaliero-Universitaria Pisana - Stabilimento di Cisanello Pisa
Italy AOU Integrata Verona Verona
Netherlands HagaZiekenhuis - Locatie Leyweg Den Haag
Netherlands Catharina Ziekenhuis Eindhoven
Netherlands Maastricht Universitair Medisch Centrum (MUMC) Maastricht
Portugal Centro Hospitalar de Lisboa Ocidental, E.P.E. Hospital de Santa Cruz Carnaxide
Spain Hospital Vall d'Hebron Barcelona
Switzerland Inselspital - Universitätsspital Bern Bern
United Kingdom Royal Infirmary of Edinburgh Edinburgh
United Kingdom The Leeds Teaching Hospitals NHS Trust - Leeds General Infirmary Leeds
United States University of Michigan Ann Arbor Michigan
United States Mission Hospital Asheville North Carolina
United States Emory Structural Heart Clinic and Emory University Midtown Atlanta Georgia
United States Piedmont Atlanta Hospital Atlanta Georgia
United States University of Colorado Aurora Colorado
United States Seton Heart Institute Austin Texas
United States Tufts Medical Center Boston Massachusetts
United States Buffalo General Medical Center Buffalo New York
United States Saint Vincent Heart Center of Indiana Carmel Indiana
United States UNC Memorial Hospital Chapel Hill North Carolina
United States University of Virginia Charlottesville Virginia
United States TriHealth / Bethesda North Hospital Cincinnati Ohio
United States Morton Plant Hospital Clearwater Florida
United States Cleveland Clinic Foundation Cleveland Ohio
United States University Hospitals Cleveland Medical Center Cleveland Ohio
United States Baylor Jack and Jane Hamilton Heart and Vascular Hospital Dallas Texas
United States Texas Health Presbyterian Hospital/Dallas Dallas Texas
United States Ascension St. John Hospital Detroit Michigan
United States NorthShore Health Systems Evanston Illinois
United States Inova Fairfax Hospital Falls Church Virginia
United States HealthPark Medical Center Fort Myers Florida
United States University of Florida Gainesville Florida
United States Spectrum Health Grand Rapids Michigan
United States UPMC Pinnacle Harrisburg Harrisburg Pennsylvania
United States Baylor Saint Luke's Hospital Houston Texas
United States Houston Methodist Hospital Houston Texas
United States The University of Texas Health Science Center at Houston Houston Texas
United States University of Texas Health Sciences Center at Houston - Center for Advanced Heart Failure Houston Texas
United States University of Iowa Hospitals and Clinics Iowa City Iowa
United States University of Kansas Medical Center Kansas City Kansas
United States Scripps Memorial Hospital La Jolla California
United States Cedars Sinai Medical Center Los Angeles California
United States Wellstar Kennestone Hospital Marietta Georgia
United States Mount Sinai Medical Center Miami Beach Florida
United States J.W. Ruby Memorial Hospital/West Virginia University Morgantown West Virginia
United States Morristown Medical Center Morristown New Jersey
United States Intermountain Medical Center Murray Utah
United States St. Thomas West Hospital Nashville Tennessee
United States TriStar Centennial Medical Center Nashville Tennessee
United States Yale New Haven Hospital New Haven Connecticut
United States NYU Langone Medical Center New York New York
United States The Icahn School of Medicine at Mount Sinai New York New York
United States Weill Cornell Medical Center New York New York
United States Sentara Norfolk General Hospital Norfolk Virginia
United States Advocate Christ Medical Center Oak Lawn Illinois
United States Hospital of the University of Pennsylvania Philadelphia Pennsylvania
United States Penn Presbyterian Medical Center Philadelphia Pennsylvania
United States Allegheny General Hospital Pittsburgh Pennsylvania
United States UPMC Presbyterian Pittsburgh Pennsylvania
United States The Heart Hospital Baylor Plano Plano Texas
United States Mayo Clinic Rochester Minnesota
United States St. Cloud Hospital Saint Cloud Minnesota
United States Saint George Regional Hospital Saint George Utah
United States Missouri Baptist Medical Center Saint Louis Missouri
United States Sutter Health San Francisco California
United States Los Robles Hospital and Medical Center Thousand Oaks California
United States Hillcrest Medical Center Tulsa Oklahoma
United States WHC Washington MedStar Washington District of Columbia
United States AscensionVia Christi St. Francis Hospital Wichita Kansas
United States Lankenau Medical Center Wynnewood Pennsylvania
United States York Hospital York Pennsylvania

Sponsors (1)

Lead Sponsor Collaborator
Medtronic Cardiovascular

Countries where clinical trial is conducted

United States,  Canada,  Denmark,  Finland,  France,  Germany,  Israel,  Italy,  Netherlands,  Portugal,  Spain,  Switzerland,  United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Other Device success 30 days
Other Incidence of an early safety composite Incidence of an early safety composite at 30 days defined as:
All-cause mortality
All stroke (disabling and non-disabling)
Life-threatening bleeding
Acute kidney injury-Stage 2 or 3 (including renal replacement therapy)
Coronary artery obstruction requiring intervention
Major vascular complication
Valve-related dysfunction requiring repeat procedure (BAV, TAVR, or SAVR)
30 days
Other Hospital readmission rate for any cause 30 days
Other Incidence of clinical efficacy Incidence of clinical efficacy (after 30 days) at 12 months and annually to 5 years defined as a composite of:
All-cause mortality
All stroke (disabling and non-disabling)
Requiring hospitalizations for valve-related symptoms or worsening congestive heart failure
NYHA class III or IV
Valve-related dysfunction (mean aortic valve gradient =20 mmHg, EOA =0.9-1.1 cm2 and/or Doppler velocity index (DVI) <0. 35m/s, AND/OR moderate or severe prosthetic valve regurgitation)
12 months and annually through 5 years
Other Percentage of participants with individual clinical endpoint components including mortality, disabling stroke and heart failure rehospitalization 12 months and annually to 5 years
Other New pacemaker implantation rate 30 days, 12 months and annually to 5 years
Other Aortic valve re-intervention rate 30 days, 12 months and annually to 5 years
Other 6-minute walk test (6MWT) change from baseline 30 days, 12 months and annually to 5 years
Other Quality of Life (QoL) change from baseline (Kansas City Cardiomyopathy Questionnaire [KCCQ] QoL: KCCQ 30 days, 12 months and annually to 5 years
Other Quality of Life (QoL) change from baseline EuroQol- 5 Dimension [EQ-5D]) QoL: EQ-5D 30 days, 12 months and annually to 5 years
Other BVD BVD at 2 to 5 years annually post-procedure including any of the following:
Hemodynamic structural valve dysfunction (HSVD)
Non-structural valve dysfunction (NSVD)
Thrombosis
Endocarditis
Aortic valve re-intervention
2 to 5 years annually
Other Echocardiographic measurements Echocardiographic measurements (i.e. EOA, mean gradient, peri-valvular leak (PVL), left ventricular mass regression, and DVI (severe <0.25, moderate 0.25-0.5, mild >0.5)). Discharge, 30 days, 12 months and annually to 5 years
Other Mean gradient = 20 mmHg based on stress echocardiogram Mean gradient = 20 mmHg based on stress echocardiogram at select sites. 12 months
Primary Mortality, disabling stroke or heart failure rehospitalization Percentage of participants with all-cause mortality, disabling stroke, or heart failure rehospitalization. 12 months
Primary Bioprosthetic Valve Dysfunction (BVD) Percentage of participants with BVD (hemodynamic structural valve dysfunction, non-structural valve dysfunction, thrombosis, endocarditis, or aortic valve re-intervention) at 12 months. 12 months
Secondary Percentage of participants with BVD in female subjects 12 months
Secondary Percentage of participants with Hemodynamic Structural Valve Dysfunction (HSVD) 12 months
Secondary Aortic valve mean gradient as a continuous variable 12 months
Secondary Effective Orifice Area (EOA) as a continuous variable 12 months
Secondary Rate of moderate or severe prothesis-patient mismatch (PPM) 30 days
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