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The goal of this study is to determine the short term safety (<30 days) and efficacy (6 months) of the heterotopic implantation of the Edwards-Sapien XT valve in the inferior vena cava for the treatment of severe tricuspid regurgitation in patients who are inoperable or at a very high surgical risk for tricuspid valve replacement.
This is a prospective multi-center, non-blinded (open label), non-randomized safety and feasibility study of the heterotopic implantation of the Edwards-Sapien XT or S3 valve in the inferior vena cava for the treatment of severe tricuspid regurgitation in patients who are inoperable or at a very high surgical risk for tricuspid valve replacement.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Severe Tricuspid Regurgitation | Experimental | This is a non-blinded (open label), non-randomized safety and feasibility study of the heterotopic implantation of the Edwards Sapien 3 valve. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Heterotopic Implantation Of the Edwards-Sapien XT Transcatheter Valve in the Inferior VEna Cava | Device |
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| Measure | Description | Time Frame |
|---|---|---|
| Procedural Success | Procedural success will include both device success and no device/procedure related SAE's including: all death, all stroke, MI, new AKI grade 3, life threatening bleeding, major vascular complications (arterial or venous-requiring unplanned intervention), pericardial effusion or tamponade requiring drainage, SVC syndrome. Safety as defined by successful vascular access without unplanned major vascular complication as defined by VARC-2, delivery and retrieval of the transcatheter valve delivery system, correct position of both the vascular stent(s) and transcatheter valve in the IVC, a single valve placed within the IVC, and no need for additional surgery or re-intervention (including drainage of pericardial effusion) with the patient being alive at 30-days. | 30 days |
| Individual Patient Success | Individual patient success is defined by device success and the following: no re-hospitalizations for right sided heart failure or right sided heart failure equivalents including drainage of ascites or pleural effusions, new listing for heart transplant, VAD, or other mechanical support; improvement in one of three variables: KCCQ improvement>15 vs. baseline; 6MWT improvement> 70 meters vs. baseline; or VO2 peak improvement > 6% vs baseline.. | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Lower Extremity Edema | Measure of improvement in lower extremity (LE) edema measured by the Villalta Scale. The Villalta Scale is used to assess patients with lower extremity signs and symptoms of swelling, discoloration, or ulceration. The scale evaluates 5 patient reported items (pain, cramps, heaviness, paresthesia, pruritus) and 6 clinician-observed items (pretibial edema, skin induration, hyperpigmentation, pain during calf compression, venous ectasia, redness). Each item is graded on a four-point scale (0=none, 1=mild, 2=moderate, 3=severe). All points are added, resulting in an overall score from 0 to 33. The final Villalta score of 5-9 is mild disease, 10-14 is moderate, and ≥15 is severe disease. A 3.1 point reduction in this scale between time points is associated with improved quality of life. |
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Inclusion Criteria:
Exclusion Criteria:
20: Subject unable to personally provide informed consent 21. FEV1<30% of predicted 22. Model for End State Liver Disease (MELD) score ≥21 (calculated per reference study.
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| Name | Affiliation | Role |
|---|---|---|
| Brian P O'Neill, MD | Henry Ford Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Henry Ford Hosptial | Detroit | Michigan | 48202 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Severe Tricuspid Regurgitation | This is a non-blinded (open label), non-randomized safety and feasibility study of the heterotopic implantation of the Edwards Sapien 3 valve. Heterotopic Implantation Of the Edwards-Sapien XT Transcatheter Valve in the Inferior VEna Cava |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Apr 24, 2020 |
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| 30 days, 6 months, 1 Year |
| Stroke and Transient Ischemic Attack (TIA) | Occurrence of stroke or transient ischemic attack (TIA) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 diagnostic criteria defines stroke as a duration of a focal or global neurological deficit ≥ 24 hours; OR <24 hours if available neuroimaging documents a new hemorrhage or infarct; OR the neurological deficit results in death. VARC-2 diagnostic criteria defines TIA as a duration of a focal or global neurological deficit <24 hours, any variable neuroimaging does not demonstrate a new hemorrhage or infarct. | 30 days, 6 months, 1 year |
| Mortality | Mortality by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 criteria separate All-cause mortality into 'Cardiovascular mortality' and 'Noncardiovascular mortality'. Cardiovascular mortality is defined as any of the following criteria: Death due to proximate cardiac cause (eg, myocardial infarction, cardiac tamponade, worsening heart failure); Death caused by noncoronary vascular conditions such as neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular disease; All procedure-related deaths, including those related to a complication of the procedure or treatment for a complication of the procedure; All valve-related deaths including structural or nonstructural valve dysfunction or other valve-related adverse events; Sudden or unwitnessed death; Death of unknown cause. Noncardiovascular mortality is defined as any death in which the primary cause of death is clearly related to another condition (eg, trauma, cancer, suicide) | 30 days, 6 months, 1 year |
| Myocardial Infarction | Myocardial Infarction (MI) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 defines MI as either periprocedural MI (new ischemic symptoms or signs AND elevated cardiac biomarkers within 72 hours after the index procedure), or spontaneous MI (>72hours after the index procedure, any 1 of the following: detection of rise and/or fall of cardiac biomarkers with at least 1 value above the 99th percentile, together with the evidence of myocardial ischemia with either symptoms of ischemia, ECG changes indicative of new ischemia, new pathological Q-waves in at least two contiguous leads, or imaging evidence of a new loss of viable myocardium or new wall motion abnormality; Sudden, unexpected cardiac death involving cardiac arrest, accompanied by new ST elevation or new LBBB, and/or evidence of fresh thrombus by coronary angiogram or at autopsy, or at a time before the appearance of cardiac biomarker in the blood; or Pathological findings of an acute MI). | 30 days, 6 months, 1 Year |
| Acute Kidney Injury | Occurrence of Acute Kidney Injury (AKI) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 criteria defines AKI as any of the following: [Stage 1] Increase in serum creatinine to 150-199% OR Urine output <0.5mL/kg/h for >6 but <12hours; [Stage 2] Increase in serum creatinine to 200-299% OR Urine output <0.5 mL/kg/h for >6 but <12hours; or [Stage 3] Increase in serum creatinine to ≥300% OR Urine output <0.3mL/kg/h for ≥24hours OR Anuria for ≥12hours. | 30 days, 6 months, 1 Year |
| Major Vascular Complications | Major Vascular Complications by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 defines major vascular complications as: any aortic dissection aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudoaneurysm; Access site or access-related vascular injury leading to death, life threatening or major bleeding, visceral ischemia, or neurological impairment; Distal embolization from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage; The use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischemia or neurological impairment; Any new ipsilateral lower extremity ischemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower extremity angiogram; surgery for access site-related nerve injury; or Permanent access site-related nerve injury. | 30 days, 6 months, 1 Year |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Severe Tricuspid Regurgitation | This is a non-blinded (open label), non-randomized safety and feasibility study of the heterotopic implantation of the Edwards Sapien 3 valve. Heterotopic Implantation Of the Edwards-Sapien XT Transcatheter Valve in the Inferior VEna Cava |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Kansas City Cardiomyopathy Questionnaire (KCCQ) | Kansas City Cardiomyopathy Questionnaire (KCCQ) is a patient-reported measure of a patient's self-perceived health status scaled from 0 to 100. Scores are summarized in ranges to define patient health status: 0 to 24 is very poor to poor health, 25 to 49 is poor to fair health, 50 to 74 is fair to good health, 75 to 100 is good to excellent health. The baseline KCCQ is compared to KCCQ measures collected at follow-up to determine how an intervention affects a patient's self-perceived health status. This comparison is factored into Primary Outcome: Individual Patient Success. | Mean | Standard Deviation | units on a scale |
| ||||||||||||||||||
| 6 Minute Walk Test | 6 Minute Walk Test (6MWT) measures exercise capacity by assessing the distance a person can walk in 6 minutes. When comparing baseline to follow-up 6MWT, further distance walked in 6 minutes corresponds to an increase in exercise capacity, shorter 6MWT distance corresponds to a decrease in exercise capacity. The baseline 6MWT is compared to 6MWT measures collected at follow-up to determine how an intervention affects patient exercise capacity. This comparison is factored into Primary Outcome: Individual Patient Success. | Mean | Standard Deviation | Meters |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Procedural Success | Procedural success will include both device success and no device/procedure related SAE's including: all death, all stroke, MI, new AKI grade 3, life threatening bleeding, major vascular complications (arterial or venous-requiring unplanned intervention), pericardial effusion or tamponade requiring drainage, SVC syndrome. Safety as defined by successful vascular access without unplanned major vascular complication as defined by VARC-2, delivery and retrieval of the transcatheter valve delivery system, correct position of both the vascular stent(s) and transcatheter valve in the IVC, a single valve placed within the IVC, and no need for additional surgery or re-intervention (including drainage of pericardial effusion) with the patient being alive at 30-days. | Posted | Number | 95% Confidence Interval | Percentage of Participants | 30 days |
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| ||||||||||||||||||||||||||
| Primary | Individual Patient Success | Individual patient success is defined by device success and the following: no re-hospitalizations for right sided heart failure or right sided heart failure equivalents including drainage of ascites or pleural effusions, new listing for heart transplant, VAD, or other mechanical support; improvement in one of three variables: KCCQ improvement>15 vs. baseline; 6MWT improvement> 70 meters vs. baseline; or VO2 peak improvement > 6% vs baseline.. | Posted | Count of Participants | Participants | 30 days |
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| Secondary | Lower Extremity Edema | Measure of improvement in lower extremity (LE) edema measured by the Villalta Scale. The Villalta Scale is used to assess patients with lower extremity signs and symptoms of swelling, discoloration, or ulceration. The scale evaluates 5 patient reported items (pain, cramps, heaviness, paresthesia, pruritus) and 6 clinician-observed items (pretibial edema, skin induration, hyperpigmentation, pain during calf compression, venous ectasia, redness). Each item is graded on a four-point scale (0=none, 1=mild, 2=moderate, 3=severe). All points are added, resulting in an overall score from 0 to 33. The final Villalta score of 5-9 is mild disease, 10-14 is moderate, and ≥15 is severe disease. A 3.1 point reduction in this scale between time points is associated with improved quality of life. | Incomplete data for these follow-up time frames. | Posted | Mean | Standard Deviation | Villalta Scale Score | 30 days, 6 months, 1 Year |
|
| ||||||||||||||||||||||||||
| Secondary | Stroke and Transient Ischemic Attack (TIA) | Occurrence of stroke or transient ischemic attack (TIA) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 diagnostic criteria defines stroke as a duration of a focal or global neurological deficit ≥ 24 hours; OR <24 hours if available neuroimaging documents a new hemorrhage or infarct; OR the neurological deficit results in death. VARC-2 diagnostic criteria defines TIA as a duration of a focal or global neurological deficit <24 hours, any variable neuroimaging does not demonstrate a new hemorrhage or infarct. | Incomplete data for these follow-up time frames. | Posted | Count of Participants | Participants | 30 days, 6 months, 1 year |
|
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| Secondary | Mortality | Mortality by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 criteria separate All-cause mortality into 'Cardiovascular mortality' and 'Noncardiovascular mortality'. Cardiovascular mortality is defined as any of the following criteria: Death due to proximate cardiac cause (eg, myocardial infarction, cardiac tamponade, worsening heart failure); Death caused by noncoronary vascular conditions such as neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular disease; All procedure-related deaths, including those related to a complication of the procedure or treatment for a complication of the procedure; All valve-related deaths including structural or nonstructural valve dysfunction or other valve-related adverse events; Sudden or unwitnessed death; Death of unknown cause. Noncardiovascular mortality is defined as any death in which the primary cause of death is clearly related to another condition (eg, trauma, cancer, suicide) | Incomplete data for these follow-up time frames. | Posted | Count of Participants | Participants | 30 days, 6 months, 1 year |
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| Secondary | Myocardial Infarction | Myocardial Infarction (MI) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 defines MI as either periprocedural MI (new ischemic symptoms or signs AND elevated cardiac biomarkers within 72 hours after the index procedure), or spontaneous MI (>72hours after the index procedure, any 1 of the following: detection of rise and/or fall of cardiac biomarkers with at least 1 value above the 99th percentile, together with the evidence of myocardial ischemia with either symptoms of ischemia, ECG changes indicative of new ischemia, new pathological Q-waves in at least two contiguous leads, or imaging evidence of a new loss of viable myocardium or new wall motion abnormality; Sudden, unexpected cardiac death involving cardiac arrest, accompanied by new ST elevation or new LBBB, and/or evidence of fresh thrombus by coronary angiogram or at autopsy, or at a time before the appearance of cardiac biomarker in the blood; or Pathological findings of an acute MI). | Incomplete data for these follow-up time frames. | Posted | Count of Participants | Participants | 30 days, 6 months, 1 Year |
|
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| Secondary | Acute Kidney Injury | Occurrence of Acute Kidney Injury (AKI) by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 criteria defines AKI as any of the following: [Stage 1] Increase in serum creatinine to 150-199% OR Urine output <0.5mL/kg/h for >6 but <12hours; [Stage 2] Increase in serum creatinine to 200-299% OR Urine output <0.5 mL/kg/h for >6 but <12hours; or [Stage 3] Increase in serum creatinine to ≥300% OR Urine output <0.3mL/kg/h for ≥24hours OR Anuria for ≥12hours. | Incomplete data for these follow-up time frames. | Posted | Count of Participants | Participants | 30 days, 6 months, 1 Year |
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| Secondary | Major Vascular Complications | Major Vascular Complications by Valve Academic Research Consortium (VARC-2) criteria. VARC-2 defines major vascular complications as: any aortic dissection aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudoaneurysm; Access site or access-related vascular injury leading to death, life threatening or major bleeding, visceral ischemia, or neurological impairment; Distal embolization from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage; The use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischemia or neurological impairment; Any new ipsilateral lower extremity ischemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower extremity angiogram; surgery for access site-related nerve injury; or Permanent access site-related nerve injury. | Incomplete data for these follow-up time frames. | Posted | Count of Participants | Participants | 30 days, 6 months, 1 Year |
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1 year
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Severe Tricuspid Regurgitation | This is a non-blinded (open label), non-randomized safety and feasibility study of the heterotopic implantation of the Edwards Sapien 3 valve. Heterotopic Implantation Of the Edwards-Sapien XT Transcatheter Valve in the Inferior VEna Cava | 5 | 7 | 7 | 7 | 1 | 7 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Stroke and TIA | Nervous system disorders | Systematic Assessment |
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| Myocardial Infarction | Cardiac disorders | Systematic Assessment |
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| Acute Kidney Injury | Renal and urinary disorders | Systematic Assessment |
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| Major vascular complications | Vascular disorders | Systematic Assessment |
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| Lower Extremity Edema | Cardiac disorders | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Gastrointestinal Bleed | Gastrointestinal disorders | Systematic Assessment |
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| Heart Failure | Cardiac disorders | Systematic Assessment |
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| Shortness of Breath | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
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This was an early feasibility study. The study did not achieve its intended enrollment of patients.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Brian O'Neill | Henry Ford Health | 313-970-6483 | boneil3@hfhs.org |
| Mar 20, 2025 |
| Prot_SAP_ICF_000.pdf |
| ID | Term |
|---|---|
| D014262 | Tricuspid Valve Insufficiency |
| ID | Term |
|---|---|
| D006349 | Heart Valve Diseases |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| Unknown or Not Reported |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| Participants |
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| Participants |
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