HumRes61062
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SNCTP000005257
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BASEC2022-D0050
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NCT04889872
The PROGRESS Study: A Prospective, Randomized, Controlled Trial to Evaluate Treatment of Moderate Aortic Stenosis by Clinical Monitoring or Transcatheter Aortic Valve Replacement
Résumé de l'étude
This study will evaluate the benefit of the SAPIEN 3™ and SAPIEN 3 Ultra™ transcatheter heart valves in patients with moderate, calcified aortic stenosis. Patients are randomly assigned to one of two groups in a 1:1 ratio. 1) In the treatment group, the aortic valve is replaced with the Edwards SAPIEN 3 or Edwards SAPIEN 3 Ultra system. The type of procedure for this medical device is called Transcatheter Aortic Valve Replacement (TAVR). 2) in the surveillance group, the heart valve is not replaced. However, the doctor will continue to carry out optimal drug treatment and closely monitor the state of health.
(BASEC)
Intervention étudiée
Aortic valve replacement using a minimally invasive surgical technique
(BASEC)
Maladie en cours d'investigation
moderate, calcified aortic stenosis
(BASEC)
Critères de participation
• 65 years of age or older at time of randomization • Moderate AS as judged by Echo Core Lab: - Aortic valve area (AVA) / aortic valve area index (AVAi): o AVA 1.0 - 1.5 cm2; OR o AVA < 1.0 with AVAi > 0.6 cm2/m2 if BMI < 30 kg/m2; OR o AVA < 1.0 with AVAi > 0.5 cm2/m2 if BMI ≥ 30 kg/m2 AND - Peak velocity 3.0 - < 4.0 m/s OR mean gradient 20 - < 40 mmHg • The patient meets at least one of the following criteria: - Valve-related symptoms including New York Heart Association (NYHA) Functional Class ≥ II, dyspnoea, angina pectoris, dizziness, pre-syncope, or syncope considered AS-related - LVEF < 60% - Diastolic dysfunction (≥ Grade 2) according to American Society of Echocardiography1 guidelines (i.e., E/e' > 14, left atrial volume index > 34 mL/m2, or tricuspid regurgitation velocity > 2.8m/sec) - Stroke volume index < 35 mL/m2 - Persistent atrial fibrillation or an episode of paroxysmal atrial fibrillation within 6 months prior to randomisation - NT Pro BNP > 3x normal - Elevated calcium score by computed tomography (CT) Core Lab (> 1200 AU for females and > 2000 AU for males) • The subject or their legal representative has been informed of the nature of the study, agrees to the provisions and has given written informed consent. (BASEC)
Critères d'exclusion
• Unsuitable size of native aortic annulus for THV • The aortic valve is unicuspid or noncalcified • Pre-existing mechanical or bioprosthetic aortic valve replacement • Severe aortic regurgitation (>3+) • Previous balloon aortic valvuloplasty (BAV) to treat severe aortic stenosis • LVEF < 20% • Left ventricular outflow tract (LVOT) calcification, which would increase the risk of annular rupture or significant paravalvular leak (PVL) after TAVR • Evidence of intracardiac mass, thrombus, or vegetation • Coronary or aortic valve anatomy that increases the risk of coronary artery obstruction after TAVR • Myocardial infarction within 30 days prior to randomization • Hypertrophic cardiomyopathy with subvalvular obstruction or restrictive cardiomyopathy • Any concomitant valvular disease requiring surgical or transcatheter intervention. • Significant untreated coronary artery disease requiring revascularization • Any surgical or transcatheter procedure within 30 days prior to randomization • Active bacterial endocarditis within 180 days prior to randomization • Stroke or transient ischemic attack (TIA) within 90 days prior to randomization • Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 30 days prior to randomization • Severe chronic obstructive pulmonary disease (COPD, or currently using oxygen at home • Hemodynamic or respiratory instability requiring inotropic or mechanical support within 30 days prior to randomization • liver disease • Renal insufficiency and/or renal replacement therapy • Significant frailty • Leukopenia, anemia, thrombocytopenia • Intolerance or condition requiring treatment (BASEC)
• 65 years of age or older at time of randomization • Moderate AS as judged by Echo Core Lab: - Aortic valve area (AVA) / aortic valve area index (AVAi): o AVA 1.0 - 1.5 cm2; OR o AVA < 1.0 with AVAi > 0.6 cm2/m2 if BMI < 30 kg/m2; OR o AVA < 1.0 with AVAi > 0.5 cm2/m2 if BMI ≥ 30 kg/m2 AND - Peak velocity 3.0 - < 4.0 m/s OR mean gradient 20 - < 40 mmHg • The patient meets at least one of the following criteria: - Valve-related symptoms including New York Heart Association (NYHA) Functional Class ≥ II, dyspnoea, angina pectoris, dizziness, pre-syncope, or syncope considered AS-related - LVEF < 60% - Diastolic dysfunction (≥ Grade 2) according to American Society of Echocardiography1 guidelines (i.e., E/e' > 14, left atrial volume index > 34 mL/m2, or tricuspid regurgitation velocity > 2.8m/sec) - Stroke volume index < 35 mL/m2 - Persistent atrial fibrillation or an episode of paroxysmal atrial fibrillation within 6 months prior to randomisation - NT Pro BNP > 3x normal - Elevated calcium score by computed tomography (CT) Core Lab (> 1200 AU for females and > 2000 AU for males) • The subject or their legal representative has been informed of the nature of the study, agrees to the provisions and has given written informed consent. (BASEC)
Critères d'exclusion
• Unsuitable size of native aortic annulus for THV • The aortic valve is unicuspid or noncalcified • Pre-existing mechanical or bioprosthetic aortic valve replacement • Severe aortic regurgitation (>3+) • Previous balloon aortic valvuloplasty (BAV) to treat severe aortic stenosis • LVEF < 20% • Left ventricular outflow tract (LVOT) calcification, which would increase the risk of annular rupture or significant paravalvular leak (PVL) after TAVR • Evidence of intracardiac mass, thrombus, or vegetation • Coronary or aortic valve anatomy that increases the risk of coronary artery obstruction after TAVR • Myocardial infarction within 30 days prior to randomization • Hypertrophic cardiomyopathy with subvalvular obstruction or restrictive cardiomyopathy • Any concomitant valvular disease requiring surgical or transcatheter intervention. • Significant untreated coronary artery disease requiring revascularization • Any surgical or transcatheter procedure within 30 days prior to randomization • Active bacterial endocarditis within 180 days prior to randomization • Stroke or transient ischemic attack (TIA) within 90 days prior to randomization • Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 30 days prior to randomization • Severe chronic obstructive pulmonary disease (COPD, or currently using oxygen at home • Hemodynamic or respiratory instability requiring inotropic or mechanical support within 30 days prior to randomization • liver disease • Renal insufficiency and/or renal replacement therapy • Significant frailty • Leukopenia, anemia, thrombocytopenia • Intolerance or condition requiring treatment (BASEC)
Lieu de l’étude
Genève, Zurich
(BASEC)
Australia, Canada, Japan, Netherlands, Switzerland, United States (ICTRP)
Sponsor
Edwards Lifesciences Sàrl
(BASEC)
Contact pour plus d'informations sur l'étude
Personne de contact en Suisse
PD Dr. Markus Kasel
00442558599
markus.kasel@clutterusz.chUSZ Klinik für Kardiologie
(BASEC)
Informations générales
Morristown Medical Center, Morristown, NJ, USA,Leiden University Medical Center, Leiden, The Netherlands,Cedars-Sinai Medical Center, Los Angeles, CA, USA,
949-250-2500
markus.kasel@clutterusz.ch(ICTRP)
Informations générales
Morristown Medical Center, Morristown, NJ, USALeiden University Medical Center, Leiden, The NetherlandsCedars-Sinai Medical Center, Los Angeles, CA, USA
949-250-2500
markus.kasel@clutterusz.ch(ICTRP)
Informations scientifiques
Morristown Medical Center, Morristown, NJ, USA,Leiden University Medical Center, Leiden, The Netherlands,Cedars-Sinai Medical Center, Los Angeles, CA, USA,
949-250-2500
markus.kasel@clutterusz.ch(ICTRP)
Nom du comité d'éthique approbateur (pour les études multicentriques, uniquement le comité principal)
Commission cantonale de Zurich
(BASEC)
Date d'approbation du comité d'éthique
25.11.2022
(BASEC)
Identifiant de l'essai ICTRP
NCT04889872 (ICTRP)
Titre officiel (approuvé par le comité d'éthique)
2021-01 The PROGRESS Trial - A Prospective, Randomized, Controlled Trial to Assess the Management of Moderate Aortic Stenosis by Clinical Surveillance or Transcatheter Aortic Valve Replacement (BASEC)
Titre académique
The PROGRESS Trial: A Prospective, Randomized, Controlled Trial to Assess the Management of Moderate Aortic Stenosis by Clinical Surveillance or Transcatheter Aortic Valve Replacement (ICTRP)
Titre public
PROGRESS: Management of Moderate Aortic Stenosis by Clinical Surveillance or TAVR (ICTRP)
Maladie en cours d'investigation
Aortic Stenosis, CalcificAortic Valve Stenosis (ICTRP)
Intervention étudiée
Device: SAPIEN 3 / SAPIEN 3 Ultra / SAPIEN 3 Ultra RESILIA (ICTRP)
Type d'essai
Interventional (ICTRP)
Plan de l'étude
Allocation: Randomized. Intervention model: Parallel Assignment. Primary purpose: Treatment. Masking: None (Open Label). (ICTRP)
Critères d'inclusion/exclusion
Key Inclusion Criteria:
1. 65 years of age or older at time of randomization
2. Moderate aortic stenosis
3. Subject has symptoms or evidence of cardiac damage/dysfunction
4. The subject or subject's legal representative has been informed of the nature of the
study, agrees to its provisions, and has provided written informed consent.
Key Exclusion Criteria:
1. Native aortic annulus size unsuitable for the THV
2. Anatomical characteristics that would preclude safe transfemoral placement of the
introducer sheath or safe passage of the delivery system
3. Aortic valve is unicuspid or non-calcified
4. Bicuspid aortic valve with an aneurysmal ascending aorta > 4.5 cm or severe
raphe/leaflet calcification
5. Pre-existing mechanical or bioprosthetic aortic valve
6. Severe aortic regurgitation
7. Prior balloon aortic valvuloplasty to treat severe AS
8. LVEF < 20%
9. Left ventricular outflow tract calcification that would increase the risk of annular
rupture or significant paravalvular leak post-TAVR
10. Cardiac imaging evidence of intracardiac mass, thrombus, or vegetation
11. Coronary or aortic valve anatomy that increases the risk of coronary artery
obstruction post-TAVR (ICTRP)
non disponible
Critères d'évaluation principaux et secondaires
Primary Effectiveness Endpoint;Primary Safety Endpoint (ICTRP)
Death, stroke, or unplanned cardiovascular hospitalization;Death, unplanned cardiovascular hospitalization, or decrease of > 10 points in Kansas City Cardiomyopathy Questionnaire (KCCQ);Unplanned cardiovascular hospitalization;Left ventricle (LV) mass index;Stroke volume index;Diastolic dysfunction = Grade 2;N-Terminal Pro B-type Natriuretic Peptide (NT-ProBNP);KCCQ overall score;Reduction in LVEF = 5% from baseline AND LVEF < 60%;New onset atrial fibrillation (ICTRP)
Date d'enregistrement
non disponible
Inclusion du premier participant
non disponible
Sponsors secondaires
non disponible
Contacts supplémentaires
Philippe G?n?reux, MD;Jeroen J Bax, MD, PhD;Raj Makkar, MD;Edwards THV Clinical Affairs, THV_CT.gov@Edwards.com, 949-250-2500, Morristown Medical Center, Morristown, NJ, USA,Leiden University Medical Center, Leiden, The Netherlands,Cedars-Sinai Medical Center, Los Angeles, CA, USA, (ICTRP)
ID secondaires
2021-01 (ICTRP)
Résultats-Données individuelles des participants
non disponible
Informations complémentaires sur l'essai
https://clinicaltrials.gov/ct2/show/NCT04889872 (ICTRP)
Résultats de l'essai
Résumé des résultats
non disponible
Lien vers les résultats dans le registre primaire
non disponible