Exploratory Study of the Edwards Transcatheter Atrial Shunt System (ALt FLOW CANADA)

Heart Failure Clinical Trial

Official title:

Exploratory Study of the Edwards Transcatheter Atrial Shunt System (ALt FLOW CANADA)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04000607
• Other study ID #: 2018-11
• Status: Recruiting
• Phase: N/A
• Start date: January 1, 2019
• Est. completion date: February 2023

Study information

• Verified date: July 2020
• Source: Edwards Lifesciences
• Contact: Melissa Arteaga
• Phone: 949-250-2002
• Email: Melissa_Arteaga[@]edwards.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The Exploratory study of the Edwards Transcatheter Atrial Shunt System is a multi-center, prospective, exploratory study to evaluate initial clinical safety, device functionality, and effectiveness of the Edwards Transcatheter Atrial Shunt System.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: February 2023
• Est. primary completion date: January 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Signed and dated approved informed consent form prior to study related procedures

2. Eighteen years of age or older

3. Chronic symptomatic Heart Failure (HF) documented by the following:

1. NYHA class II with a history of NYHA class III or greater; NYHA class III, OR ambulatory NYHA class IV within last 12 months AND

2. = 1 HF hospital admission (with HF as the primary, or secondary diagnosis); OR treatment with intravenous (IV) or intensification of oral diuresis for HF in a healthcare facility (emergency department/acute care facility) within the 12 months prior to study entry

4. In the judgment of the investigator, subject is on stable Guideline Directed Medical Therapy (GDMT) for heart failure and management of potential comorbidities according to current ACCF/AHA Guidelines and that is expected to be maintained without change for 3 months

5. Elevated LA (or PCWP) pressure of > 15 mmHg at rest or > 25 mmHg during supine ergometer exercise stress test as measured at end-expiration; AND the LA (or PCWP) exceeds right atrial pressure (RAP) by > 5 mmHg at rest or > 10 mmHg during supine ergometer exercise stress test as measured at end-expiration

6. Willing to attend study follow-up assessments for up to 3 years

Exclusion Criteria:

1. Severe heart failure defined as one or more of the below:

1. ACC/AHA/ESC Stage D heart failure, non-ambulatory NYHA Class IV HF

2. If BMI < 30, Cardiac index < 2.0 L/min/m2

3. If BMI = 30, Cardiac index < 1.8 L/min/m2

4. Inotropic infusion (continuous or intermittent) within the past 6 months

5. Patient is on the cardiac transplant waiting list

6. LVEF < 20%

2. Presence of significant valve disease defined by the site cardiologist as:

1. Mitral valve regurgitation defined as grade > 3+ MR or > moderate MS

2. Tricuspid valve regurgitation defined as grade > 2+ TR

3. Aortic valve disease defined as > 2+ AR or > moderate AS

3. MI and/or any therapeutic invasive cardiac procedure within past 3 months; or current indication for coronary revascularization;

4. Valve replacement or surgical annuloplasty within the past 12 months

5. Cardiac Resynchronization Therapy initiated, stroke or transient ischemic attack (TIA) within the past 6 months

6. Hemodynamic instability within 30 days of scheduled implant procedure

7. Patient requiring surgery under general anesthesia for any reason within 30 days of scheduled implant procedure

8. Clinically diagnosed hypertrophic obstructive cardiomyopathy, constrictive pericarditis or other infiltrative cardiomyopathy (eg, hemochromatosis, sarcoidosis)

9. Has renal insufficiency as determined by creatinine (S-Cr) level > 220 micrmol/L or estimated-GFR <25ml/min/1.73 m2 by CKD-Epi equation; or currently requiring dialysis

10. Significant hepatic impairment defined as 3× upper limit of normal of transaminases, total bilirubin, or alkaline phosphatase

11. Right ventricular dysfunction, defined by the site cardiologist as:

1. More than mild RV dysfunction as estimated by TTE; OR

2. TAPSE <1.4 cm; OR

3. RV size = LV size as estimated by TTE; OR

4. Echocardiographic or clinical evidence of congestive hepatopathy;

12. Evidence of pulmonary hypertension with PVR >4 Wood units

13. Performance of the 6 minute walk test with a distance <50m OR >400m

14. Subject is contraindicated to receive either dual antiplatelet therapy or warfarin (analogue); or has a documented coagulopathy.

15. Known hypersensitivity to anticoagulation therapy or contrast agent, which cannot be adequately medicated

16. Known hypersensitivity to Nickel

17. In the judgment of the investigator, life expectancy <12 months for noncardiovascular reasons

18. In the opinion of the investigator, the subject is not an appropriate candidate for the study

19. Anatomy (including implantable devices) that is not compatible with the Edwards Transcatheter Atrial Shunt System

20. Active endocarditis or infection within 3 months of scheduled implant procedure

21. Currently participating (e.g. undergoing trial specific exams/treatment/ procedures) in an investigational drug or device study. Note: trials requiring extended follow-up for products that were investigational but have since become commercially available are not considered investigational trials.

22. History of intravenous drug use in the last 12 months

23. Positive serum pregnancy test in female subjects of child-bearing potential or nursing mothers or planning on becoming pregnant during the duration of the trial

24. Patient is under guardianship

25. Known pre-existing shunting, determined to be clinically significant by the investigator

Related Conditions & MeSH terms

• Heart Failure

Intervention

Device:
• Atrial Shunt
Transcatheter treatment of symptomatic left heart failure patients

Locations

Country	Name	City	State
Canada	University of Ottawa Heart Institute	Ottawa	Ontario
Canada	Vancouver General Hospital	Vancouver	British Columbia

Sponsors (1)

Lead Sponsor	Collaborator
Edwards Lifesciences

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Composite of major adverse cardiac, cerebrovascular, renal events (MACCRE) and re-intervention for study device related complications at 30 days.		30 Days
Secondary	Device Success	Device is deployed as intended and the delivery system is successfully removed as intended at the time of the patient's exit from the implant procedure room.	Day 0
Secondary	Procedural Success	Device success with evidence of shunt patency and hospital discharge without the need for additional surgical or percutaneous intervention related to the study device including unacceptable Qp/Qs values.	10 Days post-op
Secondary	Clinical Success	Procedural success without major adverse cardiac, cerebrovascular, and renal events (MACCRE) or re-intervention for study device related complications at 30 days.	30 Days
Secondary	Performance/Effectiveness	Comparison vs baseline of Qp/Qs value at 3 & 6 months	Baseline, 3 months, 6 months
Secondary	Performance/Effectiveness	Improvement vs baseline of PCWP at 3 & 6 months	Baseline, 3 months, 6 months