A Study to Evaluate the Safety and Performance of LuX-Valve Plus System for Tricuspid Replacement

Tricuspid Regurgitation Clinical Trial

Official title:

TRIal to Evaluate TraNsvenous TrIcuspid Valve ReplacemenT With LuX-Valve Plus System in Patients With Severe or Greater Tricuspid Regurgitation -- SafetY and Clinical Performance

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05436028
• Other study ID #: JSNL-CIP-TVS02-01CE
• Status: Recruiting
• Phase: N/A
• Start date: May 23, 2023
• Est. completion date: August 31, 2030

Study information

• Verified date: March 2024
• Source: Jenscare Scientific
• Contact: Lei Xia
• Phone: +8618514254641
• Email: xialei[@]jenscare.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a prospective, single-arm, multi-center trial to evaluate the LuX-Valve Plus system for treating symptomatic severe or greater TR in patients who are deemed high risk for tricuspid surgery.

Treatment with the LuX-Valve Plus system may enable patients with tricuspid regurgitation to have a complete tricuspid valve replacement with a minimally invasive approach.

A total of 93 subjects will be enrolled at up to 20 institutions worldwide. No single institution will be allowed to register more than 25% of total subjects. There is no minimum number of subjects to be registered at any site.

Up to an additional 42 roll-in subjects, up to 3 per site, may be enrolled by operators without prior experience with the LuX-Valve Plus system to gain hands-on experience. The data of roll-in subjects will not count towards the overall enrollment cap. Safety and effectiveness results of roll-in subjects will be reported separately.

All subjects will be evaluated at baseline, discharge, 30 days, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years post-procedure

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 135
• Est. completion date: August 31, 2030
• Est. primary completion date: June 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

1. Age=50 years at time of consent

2. Severe or greater TR (=3+) assessed on transthoracic echocardiography by Echo Core Lab (ECL) using a 5-grade classification

3. New York Heart Association (NYHA) Class III or IV

4. In the judgment of the Site Heart Team, the subject has been adequately treated per applicable standards, including optimal medical therapy with diuretics

5. The Site Heart Team determined that the subject is appropriate for transcatheter tricuspid valve replacement, and the subject is at high risk for tricuspid valve surgery

6. Subject must provide written informed consent prior to any trial related procedure

Exclusion Criteria:

1. Systolic pulmonary artery pressure (sPAP) > 60 mmHg assessed by echocardiography

2. Left Ventricular Ejection Fraction (LVEF) <40%

3. Evidence of intracardiac mass, thrombus or vegetation

4. Anatomical structures precluding proper device deployment or device vascular access, evaluated by echo or CT

5. Ebstein Anomaly or congenital right ventricular dysplasia

6. Surgical correction is indicated for other concomitant valvular disease (e.g., severe aortic, mitral and/or pulmonic valve stenosis and/or regurgitation) Subjects with concomitant valvular disease may treat their respective valve first, and wait 2 months before being reassessed for the trial.

7. Pre-existing prosthetic valve(s) with clinically significant prosthetic dysfunction

8. Sepsis or active endocarditis within 3 months, or infections requiring antibiotic therapy within 2 weeks prior to the planned procedure

9. Untreated clinically significant coronary artery disease requiring revascularization

10. Acute myocardial infarction or unstable ischemia-related angina within prior 30 days

11. Any percutaneous coronary, intracardiac or carotid intervention within 30 days

12. Cerebrovascular stroke (ischemic or bleeding) within prior 3 months to enrollment

13. Active peptic ulcer or active gastrointestinal (GI) bleeding within prior 3 months to enrollment

14. Inability to tolerate anticoagulation or antiplatelet therapy

15. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or mechanical hemodynamic support

16. Renal insufficiency (eGFR < 30 ml/min per the Cockcroft-Gault formula) and/or renal replacement therapy at the time of screening

17. Chronic liver failure or cirrhosis with MELD-Albumin Score = 12

18. Severe lung disease or patient dependent on home oxygen and deemed unsuitable by the local heart team or eligibility committee for the study.

19. Futility with estimated life expectancy<12 months.

20. Subjects currently participating in another clinical trial of an investigational drug or device that has not yet completed its primary endpoint.

Related Conditions & MeSH terms

• Tricuspid Regurgitation
• Tricuspid Valve Insufficiency

Intervention

Device:
• Transcatheter Tricuspid Valve Intervention
Due to unsustainable effect of medical therapy and high risks of surgical treatment, transcatheter tricuspid valve intervention (TTVI) has been a major field of study in the world in the last 10 years. TTVI could potentially reduce TR with lower periprocedural risk and improve the patient's clinical status and prognosis. Per the ESC guidelines for surgical and interventional treatment of tricuspid regurgitation (2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease), Transcatheter intervention for symptomatic secondary severe TR may be considered in inoperable patients at a Heart Valve Centre with expertise in the treatment of tricuspid valve disease (Class IIb). 20 Transcatheter tricuspid treatment options can be divided into categories based on their mechanism of action: coaptation enhancement (edge-to-edge repair and spacer device), annuloplasty devices, caval valve implantation and valve replacement.

Locations

Country	Name	City	State
France	Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux	Bordeaux	Gironde

Sponsors (1)

Lead Sponsor	Collaborator
Jenscare Scientific

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	A composite endpoint of Major Adverse Event (MAE) at 30 days post procedure	A composite endpoint of Major Adverse Event (MAE) at 30 days post procedure, as listed below: Cardiovascular Mortality Myocardial Infarction (MI) Stroke New onset renal failure requiring unplanned dialysis or renal replacement therapy Severe Bleeding (includes fatal, life-threatening and extensive bleeding as defined by MVARC) Non-selective tricuspid valve surgery or transcatheter re-intervention post procedure Major cardiac structural complications Major access site and vascular complications New pacemaker implantation due to AV block	30 days post procedure
Secondary	Acute Secondary Endpoints-Device Success Rate	Device success is defined as successful deployment of the device and removal of the delivery system as planned, with no unplanned surgery related to the device or access procedure.	From the first skin incision for the investigational device to the time patient's exist from OR/Cath lab,assessed up to 24 hours post procedure.
Secondary	Acute Secondary Endpoints-Procedural Success Rate	Device success without clinically significant PVL, as determined by the Echo Core Lab (ECL) assessment of a discharge TTE. Subjects who die or undergo tricuspid valve surgery before discharge are procedure failures.	7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure
Secondary	Acute Secondary Endpoints-Clinical Success Rate at 30 days	Procedural success without MAEs at 30 days.	at 30 days
Secondary	Clinical and Functional Endpoints-All-cause mortality	All-cause mortality	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Cardiovascular mortality	Cardiovascular mortality	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Heart failure hospitalization	Heart failure hospitalization	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Tricuspid valve surgery or transcatheter re-intervention	Tricuspid valve surgery or transcatheter re-intervention	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-NYHA Functional Class	NYHA Functional Class	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Distance of 6-Minute Walk Test (6MWT)	Distance of 6-Minute Walk Test (6MWT)	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Kansas City Cardiomyopathy Questionnaire (KCCQ)	Kansas City Cardiomyopathy Questionnaire (KCCQ):Scores are transformed to a range of 0-100,in which higher scores reflect better health status.	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Clinical and Functional Endpoints-Edema assessment	Edema assessment (1+ to 4+)	at 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-TR Severity Grade	TR Severity Grade	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Vena Contracta Width	Vena Contracta Width	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Regurgitation Jet Area	Regurgitation Jet Area	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Effective Regurgitant Orifice Area (EROA)	Effective Regurgitant Orifice Area (EROA)	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Regurgitant Volume	Regurgitant Volume	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Mean Tricuspid valve inflow gradient	Mean Tricuspid valve inflow gradient	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right Atrial Volume	Right Atrial Volume	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right ventricular functions assessments:TAPSE	Right ventricular functions assessments:TAPSE	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right ventricular functions assessments:fractional area change(FAC)	Right ventricular functions assessments:fractional area change(FAC)	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right ventricular functions assessments:systolic tricuspid lateral annular tissue velocity S'	Right ventricular functions assessments:systolic tricuspid lateral annular tissue velocity S'	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right ventricular functions assessments:Hepatic vein flow reversal	Right ventricular functions assessments:Hepatic vein flow reversal	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Right ventricular functions assessments:Inferior Cava Vein Diameter/respiratory variations	Right ventricular functions assessments:Inferior Cava Vein Diameter/respiratory variations	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Systolic pulmonary artery pressure	Systolic pulmonary artery pressure	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Cardiac Output	Cardiac Output	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF)	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure
Secondary	Echocardiographic Endpoints-Paravalvular leak severity	Paravalvular leak severity	at baseline, 7-day post procedure, or at discharge if the subjects are discharged within 7 days after the procedure, 30 days, 6 months, 12 months and annually until 5 years post-procedure