Brief Title
EARLY TAVR: Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis
Official Title
Evaluation of Transcatheter Aortic Valve Replacement Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis
Brief Summary
This study will evaluate the safety and effectiveness of the Edwards SAPIEN 3/SAPIEN 3 Ultra Transcatheter Heart Valve (THV) compared with clinical surveillance (CS) in asymptomatic patients with severe, calcific aortic stenosis.
Detailed Description
This is a prospective, randomized, controlled, multicenter study. Patients will be randomized to receive either transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 / SAPIEN 3 Ultra THV or clinical surveillance. Patients will be stratified by whether they are able to perform a treadmill stress test. Patients who have a positive stress test will be followed in a registry to collect data on subsequent treatment and mortality, as applicable.
Study Type
Interventional
Primary Outcome
All-cause death, all stroke, and unplanned cardiovascular hospitalization
Secondary Outcome
Composite of 1) alive, 2) Kansas City Cardiomyopathy Questionnaire (KCCQ) score ≥75 and 3) KCCQ decrease ≤10 points
Condition
Heart Diseases
Intervention
Edwards SAPIEN 3 / SAPIEN 3 Ultra THV
Study Arms / Comparison Groups
TAVR
Description: Transcatheter aortic valve replacement (TAVR)
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Device
Estimated Enrollment
901
Start Date
July 12, 2017
Completion Date
March 2032
Primary Completion Date
March 2024
Eligibility Criteria
Inclusion Criteria: 1. 65 years of age or older 2. Severe aortic stenosis 3. Patient is asymptomatic 4. LV ejection fraction ≥ 50% 5. Society of Thoracic Surgeons (STS) risk score ≤ 10 6. The study patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent. Exclusion Criteria: 1. Patient is symptomatic 2. Patient has any concomitant valvular, aortic, coronary artery disease requiring surgery making AVR a Class I indication. 3. Native aortic annulus size unsuitable for sizes 20, 23, 26, or 29 mm THV 4. Iliofemoral vessel characteristics that would preclude safe placement of the introducer sheath. 5. Left ventricular outflow tract calcification that would increase the risk of annular rupture or significant paravalvular leak post TAVR 6. Evidence of an acute myocardial infarction ≤ 30 days before randomization 7. Aortic valve is unicuspid, bicuspid with unfavorable features for TAVR, or is non-calcified 8. Severe aortic regurgitation (>3+) 9. Severe mitral regurgitation (>3+) or ≥ moderate mitral stenosis 10. Pre-existing mechanical or bioprosthetic valve in any position 11. Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 30 days of randomization 12. Leukopenia, anemia, thrombocytopenia, history of bleeding diathesis or coagulopathy, or hypercoagulable states 13. Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation or mechanical heart assistance within 30 days of randomization 14. Hypertrophic cardiomyopathy with obstruction 15. Cardiac imaging evidence of intracardiac mass, thrombus or vegetation 16. Inability to tolerate or condition precluding treatment with anti-thrombotic therapy 17. Stroke or transient ischemic attack within 90 days of randomization 18. Renal insufficiency and/or renal replacement therapy 19. Active bacterial endocarditis within 180 days of randomization 20. Severe lung disease or currently on home oxygen 21. Severe pulmonary hypertension 22. History of cirrhosis or any active liver disease 23. Significant frailty as determined by the Heart Team 24. Significant abdominal or thoracic aortic disease that would preclude safe passage of the delivery system 25. Patient refuses blood products 26. BMI >50 kg/m2 27. Estimated life expectancy <24 months 28. Absolute contraindications or allergy to iodinated contrast that cannot be adequately treated with pre-medication 29. Currently participating in an investigational drug or another device study. 30. Active SARS-CoV-2 infection (Coronavirus-19 [COVID-19]) or previously diagnosed with COVID-19 with sequelae that could confound endpoint assessments
Gender
All
Ages
65 Years - N/A
Accepts Healthy Volunteers
No
Contacts
Philippe Généreux, MD, ,
Location Countries
Canada
Location Countries
Canada
Administrative Informations
NCT ID
NCT03042104
Organization ID
2016-07
Responsible Party
Sponsor
Study Sponsor
Edwards Lifesciences
Study Sponsor
Philippe Généreux, MD, Principal Investigator, Gagnon Cardiovascular Institute - Morristown Medical Center, Cardiovascular Research Foundation
Verification Date
January 2022