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| ID | Type | Description | Link |
|---|---|---|---|
| 2006-A00362-49 | Other Identifier | IDRCB |
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The primary objective of the CAVIAAR study is to prove that aortic valve sparing for patients with aortic root aneurysms and/or dystrophic aortic insufficiency is associated with a 45% increase of 3 years-survival rate without increased mortality or serious increased morbidity events when compared to mechanical valve replacement.
The main hypothesis of this study is that a standardized procedure of valve sparing based on external aortic annuloplasty in patients with dystrophic aortic insufficiency and/or aortic root aneurysm increases survival rate without increased mortality or serious increased morbidity events when compared with patients undergoing mechanical aortic valve replacement.
The CAVIAAR trial is a multicenter, prospective open trial. Target recruitment is 260 adults with aortic root aneurysms and/or dystrophic aortic insufficiency, enrolled in 19 french centers. Patients will undergo a standardized aortic valve sparing procedure based on aortic annuloplasty or a mechanical valve replacement (130 patients in each arm). In case of valve sparing, per-operative transoesophageal echocardiography will evaluate residual aortic insufficiency after valve repair. A conversion towards a valve replacement will be performed if residual aortic insufficiency is superior or equal to grade II.
Analysis will be on an intention-to-treat basis, completed with a per-protocol analysis. Primary endpoint will be 3-years survival free of morbidity or mortality, evaluated on a composite criterion, associating mortality; structural and non-structural valvular dysfunction, valve thrombosis, embolism, bleeding event, endocarditis, reoperations and permanent valve-related impairment. In the valve sparing group, we expect less than 5% rate of operative conversion and a significant improvement of primary endpoint. As secondary goals, quality of life and criteria of valvular coaptation will be compared between the 2 groups.
Standardization is the prerequisite for evaluation of valve sparing procedure. Aim of CAVIAAR trial is to provide evidence based medicine data for the best surgical management of patients with aortic root aneurysms and/or dystrophic aortic insufficiency.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1, preservation | Experimental | aortic valve surgery(Remodeling associated with a subvalvular aortic ring annuloplasty or double sub and supra valvular aortic annuloplasty) |
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| 2, Bentall | Sham Comparator | Mechanical aortic valve replacement(isolated or composite valve and graft replacement);actual surgical standard for dystrophic aortic roots |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Remodeling procedure associated with a subvalvular aortic ring or double sub and supra-valvular aortic annuloplasty | Procedure | Remodeling procedure associated with a subvalvular aortic ring: a) Five "U" stitches are placed inside out in the subvalvular plane (3 stitches 2 mm below the nadir of insertion of each cusp, 2 stitches below 2 of the 3 commissures at the base of the interleaflet triangles (no suture is placed at the base of the interleaflet triangle situated between the right and noncoronary sinuses to avoid injury of the bundle of His)); b) remodeling of the aortic root by scalloping a bulged graft (Gelweave ValsalvaTM); c) The 5 anchoring "U" stitches are passed through the inner aspect of the prosthetic aortic ring and tied down externally in the subvalvular position; d) anastomosis of the coronary ostia and to distal ascending aorta. |
| Measure | Description | Time Frame |
|---|---|---|
| survival free of morbidity or mortality | Primary endpoint for the CAVIAAR trial will be 3-years survival free of morbidity or mortality, evaluated on a composite criteria, associating mortality; structural and non-structural valvular dysfunction, valve thrombosis, embolism, bleeding event, endocarditis, reoperations and permanent valve-related impairment | 3 years |
| Measure | Description | Time Frame |
|---|---|---|
| separate analysis of each component of main endpoint composite criteria | during the 3 years | |
| minor bleeding events | during the 3 years | |
| Analysis of details of the operative procedures and reasons for intra-operative conversions |
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INCLUSION CRITERIA :
EXCLUSION CRITERIA :
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| Name | Affiliation | Role |
|---|---|---|
| Emmanuel LANSAC, MD,PhD | Assistance Publique - Hôpitaux de Paris | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hopital BICHAT CLAUDE BERNARD | Paris | 75018 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16500110 | Result | Lansac E, Di Centa I, Bonnet N, Leprince P, Rama A, Acar C, Pavie A, Gandjbakhch I. Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure? Eur J Cardiothorac Surg. 2006 Apr;29(4):537-44. doi: 10.1016/j.ejcts.2005.12.055. Epub 2006 Feb 24. | |
| 38914371 | Derived | Shraer N, Youssefi P, Garufi L, Debauchez M, Lansac E. External aortic annuloplasty with a dedicated expansible ring improves outcomes in remodeling root repair compared with homemade Dacron ring. J Thorac Cardiovasc Surg. 2025 May;169(5):1438-1451.e1. doi: 10.1016/j.jtcvs.2024.06.013. Epub 2024 Jun 22. |
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| Mechanical valve replacement (isolated or composite valve and graft replacement); actual surgical standard for dystrophic aortic roots | Device | Expansible Prosthetic Aortic Ring: Mechanical valve replacement (isolated or composite valve and graft replacement); actual surgical standard for dystrophic aortic roots |
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| during the intervention and in intensive care |
| cardiac rhythm (sinus rhythm or not) | at per-operation andduring the intervention |
| quality of life (Short Form SF-36) | during the 3 years |
| - Cardiac imaging (echocardiographic and CT-scan or MRI): coaptation height, systolic and diastolic diameters of the aortic root at the levels of the base of the aortic annulus, sinuses of valsalva, sino-tubular junction and ascending aorta | during the surgery and if there is reintervention |
| 36535821 | Derived | Shraer N, Youssefi P, Zacek P, Debauchez M, Leprince P, Raisky O, Lansac E. Bicuspid valve repair outcomes are improved with reduction and stabilization of sinotubular junction and annulus with external annuloplasty. J Thorac Cardiovasc Surg. 2024 Jul;168(1):60-73.e6. doi: 10.1016/j.jtcvs.2022.11.021. Epub 2022 Nov 25. |
| 25240525 | Derived | Lansac E, Bouchot O, Arnaud Crozat E, Hacini R, Doguet F, Demaria R, Leguerrier A, Jouan J, Chatel D, Lopez S, Folliguet T, Acar C, Leprince P, Langanay T, Jegaden O, Bessou JP, Albat B, Latremouille C, Fabiani JN, Fayad G, Fleury JP, Pasquet B, Debauchez M, Di Centa I, Tubach F. Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: early outcomes of the CAVIAAR multicentric prospective cohort study. J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S37-45. doi: 10.1016/j.jtcvs.2014.07.105. Epub 2014 Aug 12. |
| ID | Term |
|---|---|
| D001022 | Aortic Valve Insufficiency |
| D001014 | Aortic Aneurysm |
| D000094628 | Aortic Root Aneurysm |
| ID | Term |
|---|---|
| D000082862 | Aortic Valve Disease |
| D006349 | Heart Valve Diseases |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D000783 | Aneurysm |
| D014652 | Vascular Diseases |
| D001018 | Aortic Diseases |
| D017545 | Aortic Aneurysm, Thoracic |
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