Iron Infusion in Patients Undergoing Transcatheter Aortic Valve Implantation

Iron Infusion in Patients Undergoing Transcatheter Aortic Valve Implantation: Study Protocol of the Randomized Controlled IRON-TAVI Trial

The aim of the open-label, randomized controlled superiority IRON TAVI trial is to investigate whether intravenous iron therapy (ferric carboxymaltose) improves Health-Related Quality of Life (HRQOL) in patients with severe aortic stenosis (AS) and iron deficiency (ID), undergoing transcatheter aortic valve implantation (TAVI).

The main questions it aims to answer are:

1. Does intravenous iron therapy improve HRQOL after TAVI in patients with severe AS and ID compared to no intravenous iron therapy (standard of care)?
2. Can intravenous iron therapy enhance exercise capacity, as measured by the 6-minute walk test, after TAVI in patients with severe AS and ID compared to no intravenous iron therapy (standard of care)?

The intervention group (receiving iron therapy after TAVI) will be compared to the control group (receiving no iron therapy after TAVI (standard of care)).

Participants will:

• Provide written informed consent

• Be randomly assigned to one of two groups:

  1. Intervention group: receiving intravenous iron therapy after TAVI (1-3 administrations in the course of 12 weeks)
  2. Control group: receiving standard of care (= no iron therapy)

• Complete assessments of HRQOL and the 6-minute walk test at baseline and week 24 after TAVI.

• During follow-up visits, other clinical parameters will be collected (i.e. laboratory status, mortality status, adverse clinical events)

Inclusion Criteria:

• Patient age ≥ 65 years
• Patients with severe AS and ID undergoing successful TAVI
• ID defined as Ferritin < 100 ug/L and/or Transferrin saturation < 20%
• Ability to perform assessment of QoL (questionnaire assessment) and EC (6-MWT)
• Signed Informed Consent

Exclusion Criteria:

• Contra-indication for TAVI
• Ferritin > 400 ug/L
• Hemoglobin <5.6 mmol/L or <9 g/dL
• Hemoglobin >8.7 mmol/L or >14 g/dL in men and >8.1 mmol/L or >13 g/dL in women
• Anaemia due to known reasons other than ID and/or anticipated non-response to iron-supplementation (e.g. hemogobinopathy, bone marow disease, active cancer, unresolved active bleeding)
• Chronic liver disease (including active hepatitis) and/or screening alanine transaminase or aspartate transaminase above three times the upper limit of the normal range.
• Renal dialysis (previous, current, or planned within the next 6 months) or MDRD/CKD-EPI estimated glomerular filtration rate <15 mL/min.
• History of iron overload
• History of erythropoietin, i.v. or oral iron therapy, and blood transfusion in previous 3 months and/or such therapy planned within next 6 months
• Clinically apparent infection requiring antibiotic treatment
• Known hypersensitivity to iFCM or to any of its excipients
• Pregnancy
• Study subject participation in another TAVI related clinical study in which the primary endpoint includes mortality, hospitalization for heart failure and/or quality of life assessment.