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Clinical Trial Summary

Investigational study of Edwards Lifesciences, LLC's "Edwards SAPIEN Transcatheter Heart Valve" for non-femoral delivery, (or alternative access deliver) in patients with severe symptomatic native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement and in whom existing co-morbidities would not preclude the expected benefit from correction of the aortic stenosis. Will outcomes observed in a high-risk operable transapical native valve TAVR cohort receiving an Edwards SAPIEN device compare to inoperable patients undergoing alternative access TAVR with the Edwards SAPIEN device experience a reasonably similar incidence of 30 day adverse events?


Clinical Trial Description

Transcatheter aortic valve replacement (TAVR) using the Edwards SAPIEN valve and Retroflex 3 delivery system provides both a mortality and quality of life benefit for inoperable patients. Only the transfemoral (TF) access has been approved in the US. A substantial number of patients cannot have a TF approach due to inadequate vessel size, vessel disease, or other anatomical considerations. The pivotal study did not include an assessment of safety and effectiveness of alternative access approaches in this inoperable patient group.

Early approaches to TAVR included a femoral transvenous approach with transseptal access to the left side for delivery of the valve. This approach avoided large bore arterial catheterization, but it had unacceptable rates of complications and lacked reproducibility. Alternative access approaches have been developed because of the risks associated with inserting large caliber catheters into small, diseased femoral arteries often associated with diffuse vasculopathy. To avoid the vascular complications from femoral access, other transcatheter approaches have been developed to include open surgical access to the left ventricular apex (TA), ascending aorta, (TAO), subclavian and axillary arteries (TS), and retroperitoneal access to the iliac artery (TI) as well as distal aorta. In addition to providing TAVR to patients who cannot have TF access, additional advantages include better catheter control and safer closure of the access site. Commonly cited disadvantages include the need for surgical expertise and additional equipment, along with the potential for longer recovery, more incisional pain, greater radiation exposure for operators, unsuitable delivery catheters for alternative access sites, and a host of unique alternative access site complications.

We propose to collectively analyze 30-day safety endpoints as a lumped data group for these alternative access approaches. These data are gathered from clinical practice in real-world settings and submitted to the TVT Registry. It is expected that centers will choose among the various choices for alternative access based the causative factors underlying the need for alternative access, as well as local skill sets and experience. For this lumped data group of alternative access approaches we will compare 30-day safety results to the TA outcomes reported from Cohort A of the PARTNERS 1 trial. We recognize that these TA patients were high risk operable patients rather than inoperable patients, but no other direct comparator group is available. We reason that the TA data from this published clinical trial are high quality, represent an alternative access approach rather than TF, and will provide a frequency of safety endpoints that have been found to be acceptable both clinically and from a regulatory perspective. ;


Study Design

Observational Model: Cohort, Time Perspective: Prospective


Related Conditions & MeSH terms


NCT number NCT01787084
Study type Observational
Source The Society of Thoracic Surgeons
Contact
Status Completed
Phase N/A
Start date April 2013
Completion date March 2015

See also
  Status Clinical Trial Phase
Not yet recruiting NCT02210351 - Evaluation of Association Between Apical Dysfunction and Trans Apical Access for TAVR, in Patients With Severe Aortic Stenosis, Undergoing Trans Apical Trans Catheter Aortic Valve Replacement (TAP-TAVR). N/A
Completed NCT02956915 - Evaluation of Length of Stay After TF-TAVI
Recruiting NCT05326126 - Microvascular Function in Patients Undergoing Transcatheter Aortic Valve Implant (TAVI) for Severe Symptomatic Aortic Stenosis: Association With Myocardial Fibrosis N/A
Completed NCT04663334 - Change in Coronary Microcirculation and FFR After TAVI in Patients With Cardiovascular Comorbidities
Withdrawn NCT01742598 - Assessment of St Jude Medical Portico Re-sheathable Transapical Aortic Valve System N/A
Withdrawn NCT01927601 - Assessment of Neurologic Injury Subsequent to Transcatheter Aortic Valve Replacement: A Feasibility Study N/A