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Aortic Valve DiseaseMISSIONNCT02907463

EDWARDS INTUITY Elite Valve System

An observational study of Aortic Valve Disease and Aortic Stenosis, run by Edwards Lifesciences at 23 sites in 9 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this active, observational, open-label, non-randomized, post-market surveillance study is to confirm that EDWARDS INTUITY Elite reduces cross clamp time (XCT) in MIS setting when compared to published data with a conventional valve within the MIS setting. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Aortic Valve Disease, Aortic Stenosis
How many people
280 participants
Where
23 sitesin 9 countries
Study dates
Feb 2016to Dec 2017
Phase
Observational
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: * Adult subjects, age18 or older, that have been diagnosed with aortic stenosis or stenosis-based insufficiency requiring isolated aortic valve replacement (AVR) * Subjects whose medical records indicate they are a suitable candidate for Minimally Invasive Surgery (MIS) * Subjects whose treating physician is the Principle Investigator or a Sub-Investigator participating in the study and has been trained on the EDWARDS INTUITY Elite Valve System * Subject shall be drawn from the general patient population served by each investigational center * Candidates for this study must meet all of the following Inclusion criteria and none of the Exclusion criteria or intra-op exclusion criteria

Who may be able to join

  • Subject is 18 years or older
  • Subject is symptomatic for aortic stenosis (AS) or mixed aortic stenosis and aortic insufficiency (AS/AI) disease for which isolated surgical aortic valve replacement without concomitant procedures is indicated according to International guidelines.
  • Surgery starts with and is intended to be completed via a minimal invasive surgical approach. MIS is defined as a non-full sternotomy approach such as partial hemi-sternotomy, right anterior thoracotomy.
  • Surgery is intended to be completed with an EDWARDS INTUITY Elite Heart Valve.
  • Subject has signed and dated the investigation informed consent forms prior to any study-specific procedures are performed.
  • Subject is geographically stable and agrees to attend follow-up assessments as specified in the protocol and informed consent.

Who cannot join

  • Subject is diagnosed with pure aortic insufficiency.
  • Subject requires multiple valve replacement/repair
  • Subject has Type 0 congenital true bicuspid aortic valve (i.e. absence of raphe and commissures are positioned about 180 degrees apart) or unicuspid aortic valve.
  • Subject has severe ventricular dysfunction defined as LVEF < 25%.
  • Subject has a history of active endocarditis and/or myocarditis ≤ 3 months before the intended treatment/scheduled surgery.
  • Subject has had an acute MI ≤ 3 months before the intended treatment.
Show all 24Show fewer
  • Subject had a stroke or transient ischemic attack within six months prior to scheduled aortic valve replacement surgery.
  • Subject is oxygen or ventilator dependent.
  • Subject has life expectancy < 12 months.
  • Female subject is pregnant or lactating.
  • Subject with documented leukopenia (WBC < 3.5x 103/μL), anemia (Hb < 10.0 gm/dL or < 6.2 mmol/L), thrombocytopenia (platelet count < 100x 103/mL), or history of bleeding diathesis or coagulopathy.
  • Subject has renal insufficiency as determined by Serum creatinine
  • ≥ 200 μmol/L (2.27 mg/dL) at screening or end-stage renal disease requiring chronic dialysis.
  • Subject is currently participating in an investigational drug or device trial for which follow-up has not yet been completed.
  • Minimally Invasive access to the heart is not possible due to anatomical constraints or any other pre-existing condition.
  • Aneurysm of the aortic root and/or ascending aorta
  • Intra-operative exclusion criteria:
  • Subject has Type 0 congenital true bicuspid aortic valve (i.e. absence of raphe and commissures are positioned about 180 degrees apart) or unicuspid aortic valve. (A non-congenital bicuspid valve without a distorted annulus would not be cause for exclusion.)
  • Subject has calcium on the anterior mitral leaflet which cannot be removed.
  • Subject has extensive calcification of the aortic root.
  • Annular deformation which may or may not be caused by too extensive decalcification of the aortic annulus.
  • The position of the coronary ostia relative to the EDWARDS INTUITY Elite Aortic Valve could result in obstruction of blood flow.
  • Minimally Invasive access to the heart is not possible due to anatomical constraints or any other condition (including patient switched to a full sternotomy approach).
  • The device is not available in the correct size for the subject.

Trial locations and contacts

23 sites in 9 countries.

23 sites in 9 countries

Germany6 sites
  • Herz- und Gefäß-Klinik GmbH Bad Neustadt

    Bad Neustadt an der Saale, 97616

  • Universitätsklinikum der Ruhr-Universität Bochum Klinik für Herz- und Thoraxchirurgie

    Bochum, 44789

  • Herzzentrum Uniklinik Köln

    Cologne, 50924

  • Medizinische Hochschule Hannover

    Hanover, 30625

  • Herzzentrum Leipzig

    Leipzig, 04289

  • University Hospital Würzburg

    Würzburg, 97080

Other trials in Germany

Italy5 sites
  • G. Pasquinucci Heart Hospital - "G.Monasterio" Foundation

    Massa, 54100

  • CentroCardiologico Monzino

    Milan, 20138

  • Clinica San Gaudenzio

    Novara

  • Università Cattolica del Sacro Cuore Policlinico

    Roma, 00168

  • Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia"

    Udine, 33100

Other trials in Italy

Spain3 sites
  • Complexo Hospitalario Universitario A Coruna

    A Coruña

  • Hospital Universitario Virgen de la Arrixaca

    El Palmar, Murcia, 30120

  • Hospital Clínico San Carlos

    Madrid, 28040

Other trials in Spain

Austria2 sites
  • Universitätsklinik für Herzchirurgie Medizinische Universität Innsbruck

    Innsbruck, 6020

  • Klinisshe Abteiluing Für Herz-thoraxchirurgie

    Vienna, 1090

Other trials in Austria

France2 sites
  • CHU Bocage Central Dijon

    Dijon, 21074

  • Hôpital Cardiologique CHU Bordeaux Haut Leveque

    Pessac, 33 604

Other trials in France

United Kingdom2 sites
  • Royal Infirmary Hospital Edinburgh

    Edinburgh, EH16 4SA

  • St Thomas' Hospital

    London, SE1 7EH

Other trials in United Kingdom

Denmark1 site
  • Aarhus Universitets Hospital Skejby

    Aarhus N, 8200

Other trials in Denmark

Luxembourg1 site
  • Institut National de Chirurgie Cardiaque et Cardiologie Interventionnelle (INCCI)

    Luxembourg, 1210

Other trials in Luxembourg

Netherlands1 site
  • St Antonius Hospital

    Nieuwegein, 3430 EM / PO BOX 2500

Other trials in Netherlands

About this study

Official title: Assessing Clinical Outcomes Using the EDWARDS INTUITY Elite Valve System in Isolated AVR Using Minimally InvaSive Surgery In a EurOpean Multi-ceNter, Active, Post-market Registry

The purpose of this active, observational, open-label, non-randomized, post-market surveillance study is to confirm that EDWARDS INTUITY Elite reduces cross clamp time (XCT) in MIS setting when compared to published data with a conventional valve within the MIS setting. The published dataset will used as a control group. Then to describe short term (30 days) and long term (6 months) clinical safety, to assess and compare hemodynamic data with EDWARDS INTUITY Elite to a conventional valve at discharge and at 6 months post AVR, to assess Quality of Life at baseline, and at 6 months post AVR to assess NYHA functional class at baseline, discharge, 1 month and at 6 months post AVR to assess Fitness for hospital discharge.

Read the detailed description

Aortic valve replacement with mechanical or biological heart valves is the treatment of choice for aortic valve stenosis. Over the past several years, life expectancy has increased in industrial nations, but this has been accompanied by a rising rate of elderly patients with multiple illnesses.

Aortic stenosis remains the most common cause of adult valvular heart disease, the prevalence increasing with age. Average survival of patients treated conservatively has historically been reported as 2-5 years from the onset of symptoms. More recent studies have confirmed the dismal prognosis of severe aortic stenosis. Advanced age, reduced left-ventricular ejection fraction, congestive heart failure and renal insufficiency appear to be independent predictors of reduced survival. Asymptomatic patients with very severe aortic stenosis also share a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early surgery offers a therapeutic option to improve clinical outcomes via decreasing cardiac mortality and improving symptoms.

Bioprostheses offer several advantages over mechanical bioprostheses, the most important being freedom from anticoagulation with a low rate of thromboembolic accidents.

In response to clinical need and in support of advances in minimally invasive surgical approaches to conventional AVR, Edwards Lifesciences developed the EDWARDS INTUITY Elite Valve System to achieve clinical benefits by reducing cardiopulmonary bypass and cross clamp times, while facilitating a less invasive approach to aortic valve replacement.

The system includes the EDWARDS INTUITY Elite Valve System, Model 8300AB and the EDWARDS INTUITY Elite Delivery System, Model 8300DB; the valve is based on prior heart valve designs which have a long history of safety and effectiveness and have incorporated additional features designed to improve patient outcomes and safety.

With only 3 guiding sutures and secure balloon expandable frame, the EDWARDS INTUITY Elite Valve system is well suited for smaller incisions and tight access, with an emphasis on procedural efficiency within existing operating suite of the surgeon.

Keywords
Aortic Valve Replacement, Aortic Stenosis, EDWARDS INTUITY Elite, Rapid deployment valves
Medical subject headings
Aortic Valve Disease, Aortic Valve Stenosis

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Subject's Average Time Spent on Cardiopulmonary Cross Clamp

    Cardiopulmonary cross clamp time is the amount of time that the patient's aorta (blood vessel) is clamped by a surgical instrument used in cardiac surgery. This allows the normal blood flow to be sent to an artificial heart and lung machine to keep it at a constant temperature and oxygen level.

    Measured: At time of surgery; an average of 1 hour

Secondary outcomes (14)
  1. Subject's Average Time Spent on Cardiopulmonary Bypass.

    Cardiopulmonary bypass time is the amount of time that the patient's blood circulates through an artificial heart and lung machine during cardiac surgery.

    Measured: At time of surgery; an average of 1.5 hours

  2. Device Technical Success Rate

    The successful delivery and deployment of the EDWARDS INTUITY Elite valve and delivery system, and the subject leaving the operating room with valve in place.

    Measured: At time of surgery

  3. First Attempt Success Rate

    The successful delivery and deployment of the valve and delivery system during the first attempt, and subject leaving the operating room with EDWARDS INTUITY Elite valve in place.

    Measured: At time of surgery

  4. Procedural Success

    Procedural success is defined as device technical success followed by the absence of adverse events requiring device reoperation, requiring implantation of permanent pacemaker (with baseline sinus rhythm and no other conduction issues), or subject death, within discharge or 10 days post index procedure whichever comes first.

    Measured: Day of procedure and events occurring within 10 days of procedure

  5. Subject's Average Health Care Utilization

    The average amount of time the subjects spent in the intensive care unit and the average total length of hospital stay after their heart valve replacement procedure.

    Measured: Day of surgical procedure through discharge from the hospital, an average of 3 days and 10 days respectively.

  6. Subject's Average Mean Gradient Measurements Over Time.

    Mean gradient is the average flow of blood through the aortic valve measured in millimeters of mercury. Gradients are evaluated by echocardiography over time. Mean gradient values depend on the size and type of valve.

    Measured: Baseline, Discharge and 6 months

  7. Subject's Average Peak Gradients Measurements Over Time.

    Peak gradient is the maximum value measured of flow of blood through the aortic valve as measured in millimeters of mercury. Gradients are evaluated by echocardiography over time.

    Measured: Baseline, Discharge and 6 months

  8. Subject's Average Effective Orifice Area (EOA) Measurements Over Time

    Effective orifice area represents the cross-sectional area of the blood flow downstream of the aortic valve. Effective orifice area is evaluated by echocardiography over time.

    Measured: Baseline, Discharge and 6 months

  9. Subject's Average Effective Orifice Area Index (EOAI) Measurement Over Time.

    Effective orifice area index represents the minimal cross-sectional area of the blood flow downstream of the aortic valve divided by the person's body surface area. Effective orifice area index is evaluated by echocardiography over time.

    Measured: Discharge and 6 months

  10. Subject's Average Performance Index Measurements Over Time.

    Performance index is defined as the subject's effective orifice area (the cross-sectional area of the blood flow downstream of the aortic valve) divided by the subject's pre-implant orifice area. Effective orifice area is evaluated by echocardiography over time.

    Measured: Baseline, Discharge and 6 months

  11. Subject's Average Cardiac Output Over Time

    The amount of blood the heart pumps through the circulatory system in a minute.

    Measured: Baseline, Discharge and 6 months

  12. Subject's Average Cardiac Index

    A measure of cardiac output per square meter of body surface area

    Measured: Discharge and 6 months

  13. Subject's Amount of Paravalvular Leak Over Time.

    Paravalvular leak refers to blood flowing through a channel between the implanted artificial valve and the cardiac tissue as a result of inappropriate sealing. Paravalvular leak is evaluated by echocardiography over time. It is assessed on a scale from minimum of 0 to maximum of 4, where 0 = no leak, 1 = a trace leak, 2 = a mild leak, 3 = a moderate leak, and 4 = a severe leak. Higher numbers on the scale show a worsening outcome.

    Measured: Discharge and 6 months

  14. Subject's Amount of Aortic Valvular Regurgitation Over Time.

    Aortic valvular regurgitation occurs when the aortic valve in the heart does not close tightly allowing some of the blood that was pumped out of the heart to leak back into it. Aortic valvular regurgitation is evaluated by echocardiography over time. It is assessed on a scale from minimum of 0 to maximum of 4, where 0 = no leak, 1 = a trace leak, 2 = a mild leak, 3 = a moderate leak, and 4 = a severe leak. Higher numbers on the scale show a worsening outcome.

    Measured: Discharge and 6 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Sep 2016 (estimated)
  2. Study startFeb 2016
  3. Primary completionApr 2017
  4. Study completionDec 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Other
Time perspective
Other
Enrolment
280 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02907463
Sponsor's protocol ID
2015-05
Acronym
MISSION
Status last verified
Nov 2019
First submitted
29 Jun 2016
Last updated
22 Nov 2019
Data monitoring committee
Yes

Publications

  • Laufer G, Strauch JT, Terp KA, Salinas M, Arribas JM, Massetti M, Andreas M, Young CP. Real-world 6-month outcomes of minimally invasive aortic valve replacement with the EDWARDS INTUITY Elite valve system. Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2):ivac083. doi: 10.1093/icvts/ivac083.

    PubMed 35394527

Questions about this trial

What is this clinical trial studying?

An observational study of Aortic Valve Disease and Aortic Stenosis, run by Edwards Lifesciences at 23 sites in 9 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Nov 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 23 sites in Germany, Italy, Spain, Austria, France and 4 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 8 Nov 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Subject's Average Time Spent on Cardiopulmonary Cross Clamp (time frame: At time of surgery; an average of 1 hour). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02907463, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Nov 2019.

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