Aortic Valve StenosisSCOPE INCT03011346
Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis.
A study testing Symetis ACURATE neo/TF transfemoral TAVI system and Edwards Sapien 3 Transcatheter Heart Valve in people with Aortic Valve Stenosis, run by Insel Gruppe AG, University Hospital Bern at 20 sites in 4 countries.
Trial summary
Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). Read more about this study
- Who is it for?
- Ages 75 years and older
- Conditions the study is for
- Aortic Valve Stenosis
- What is being tested?
- Symetis ACURATE neo/TF transfemoral TAVI system and Edwards Sapien 3 Transcatheter Heart Valve
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 739 participants
- Where
- 20 sitesin 4 countries
- Study dates
- 8 Feb 2017to 16 Feb 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 75 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Patient with severe aortic stenosis defined by an aortic valve area (AVA) < 1cm2 or AVA indexed to body surface area (BSA) of < 0.6 cm2/m2, including low-flow severe aortic stenosis defined by stroke volume index (SVI) < 35ml/m2, as assessed by integration of echocardiographic and invasive measurements
- Subject is symptomatic (heart failure symptoms with New York Heart Association (NYHA) Functional Class > I, angina or syncope)
- Patient is considered at increased risk for mortality if undergoing conventional surgical aortic valve replacement or judged as not operable as determined either
- by a Logistic EuroSCORE > 20 % OR
- by a STS-PROM score > 10% OR
- by the heart team consisting of at least one cardiologist and cardiac surgeon based on the integration of individual clinical and anatomical factors not captured by risk-scores, the patient's age, frailty and life-expectancy
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- The heart team agrees on eligibility of the patient for participation and that TAVI by transfemoral access constitutes the most appropriate treatment modality, from which the patient will likely benefit most
- Aortic annulus dimensions suitable for both valve types (area range: 338-573 mm2 AND perimeter range: 66-85 mm) based on ECG-gated multislice computed tomographic measurements. Findings of transesophageal echocardiography (TEE) and conventional aortography should be integrated in the anatomic assessment if available
- Arterial aorto-iliac-femoral axis suitable for transfemoral access with a minimum access vessel diameter ≥ 6 mm as assessed by multislice computed tomographic angiography and/or conventional angiography
- Written informed consent of the patient or her/his legal representative
- Patient understands the purpose, the potential risks as well as benefits of the trial and is willing to participate in all parts of the follow-up
Who cannot join
- Non-valvular aortic stenosis
- Congenital aortic stenosis or unicuspid or bicuspid aortic valve
- Non-calcific acquired aortic stenosis
- Anatomy not appropriate for transfemoral transcatheter aortic valve implantation due to size of the aortic annulus or degree or eccentricity of calcification of the native aortic valve or tortuosity of the aorta or ilio-femoral arteries
- Emergency procedure including patients in cardiogenic shock (low cardiac output, vasopressor dependence, mechanical hemodynamic support)
- Severely reduced left ventricular (LV) function (ejection fraction < 20%)
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- Pre-existing prosthetic heart valve in aortic position
- Presence of mitral valve prosthesis
- Concomitant planned procedure except for percutaneous coronary intervention (PCI)
- Planned non-cardiac surgery within 30 days
- Stroke within 30 days of the procedure.
- Myocardial infarction within 30 days of the procedure (except type 2)
- Evidence of intra-cardiac mass, thrombus or vegetation
- Severe coagulation conditions
- Inability to tolerate anticoagulation/anti-platelet therapy
- Active bacterial endocarditis or other active infections
- Hypertrophic cardiomyopathy with or without obstruction
- Contraindication to contrast media or allergy to nitinol
- Participation in another trial, which would lead to deviations in the preparation or performance of the intervention or the post-implantation management from this protocol
Trial locations and contacts
20 sites in 4 countries.
20 sites in 4 countries
Germany15 sites
Klinkum Augsburg
Augsburg, 86156
Zentralklinik Bad Berka
Bad Berka, 99437
Herz- und Gefässzentrum Bad Beversen
Bad Bevensen, 29549
Kerckhoff-Klinik
Bad Nauheim, 61231
Herz- und Gefäss-Klinik GmbH Bad Neustadt
Bad Neustadt an der Saale, Bad Neustadt, 97616
Herzzentrum Uniklinik Köln
Cologne, 50931
St.-Johannes-Hospital
Dortmund, 44137
Herzzentrum Dresden
Dresden, 01307
Universitäres Herzzentrum Hamburg GmbH
Hamburg, 20251
Städtisches Klinikum Karlsruhe
Karlsruhe, 76133
ViDia Kliniken
Karlsruhe, 76135
Klinik für Herzchirurgie Karlsruhe
Karlsruhe, 76185
Herzzentrum Leipzig
Leipzig, 04289
Deutsches Herzzentrum München
München, 80636
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie
Regensburg, 93053
Switzerland3 sites
Bern University Hospital
Bern, 3010
Luzerner Kantonsspital
Lucerne, 6000
Universitätsspital Zürich
Zurich, 8091
About this study
Official title: Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach.
Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). Many novel devices are currently being developed and established transcatheter heart valves undergo design reiterations to address limitations and reduce complication rates associated with the device and implantation procedure. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves. The aim of this study is to assess non-inferiority of the self-expandable Symetis ACURATE neo/TF in comparison to the balloon-expandable Edwards SAPIEN 3 transcatheter aortic valve bioprosthesis with regard to early safety and clinical efficacy at 30 days.
Read the detailed description
Background:
Transcatheter aortic valve implantation (TAVI) is an established and valuable treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). The use of TAVI is rapidly expanding worldwide and the indications for TAVI are widening into lower risk populations in view of favorable outcomes among high and intermediate risk patients. Many novel devices are currently developed or established devices undergo design reiterations to address limitations, such as vascular access complications, paravalvular regurgitation, and atrio-ventricular conductance disturbances. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves.
The Symetis ACURATE neo/TF, a self-expandable transcatheter valve delivered via transfemoral access, gained Conformité Européenne (CE) marking in September 2014 after showing favorable procedural and short term results. The SCOPE I trial will compare its performance to the balloon-expandable Edwards SAPIEN 3, a widely used and well-established transcatheter heart valve of the second generation, in a randomized fashion.
Objectives:
The primary objective is the comparison of the Symetis ACURATE neo/TF to the Edwards SAPIEN 3 transcatheter aortic bioprosthesis with regard to early safety and clinical efficacy at 30 days. Secondary objectives involve the comparison between the two devices with regard to secondary clinical and echocardiographic endpoints at 30 days, 1 year and 3 years.
Methods:
Sample Size: Based on an anticipated incidence proportion of 22% for the primary non-hierarchical composite endpoint at 30 days in both treatment arms, a non-inferiority margin of 7.7%, a power of 80%, a one-tailed significance level of α = 0.05, and a low attrition rate, the total required sample size amounts to 730 patients.
Design: Patients will be allocated to the Symetis ACURATE neo/TF or the Edwards SAPIEN 3 bioprosthesis at a 1:1 ratio by means of a randomly permuted block randomisation stratified on study center and Society of Thoracic Surgeons' predicted risk of mortality score (STS-PROM) strata (< 3%, ≥ 3 to < 8%, ≥ 8%).
Analysis: Estimates of the risk-differences between the two treatment arms with regard to the primary endpoint will be pooled over the predefined STS-PROM strata by means of the Cochran-Mantel-Haenszel method and Wald-type confidence limits will be calculated using the Sato variance estimator. The non-inferiority assumption will be tested at a one-sided significance level with a type I error rate (α) = 0.05. The analysis of the primary composite endpoint will be conducted according to the intention-to-treat (ITT) and the per protocol (PP) principle and non-inferiority should be claimed only if met by both.
In case non-inferiority is established, a superiority analysis will be performed using a two-tailed significance level with a type I error rate of α = 0.05. Further secondary analyses will evaluate between group differences in relation to demographic, clinical, procedural, functional and imaging characteristics. Pre-specified subgroup analyses will be conducted by use of appropriate interaction tests contrasting categories of sex, STS-PROM score (< 3%, ≥ 3 to < 8%, ≥ 8%), left ventricular ejection fraction (< 50% vs. ≥ 50%), and native aortic valve eccentricity index (≤ 0.25 vs. > 0.25).
- Conditions
- Aortic Valve Stenosis
- Being tested
- Symetis ACURATE neo/TF transfemoral TAVI system, Edwards Sapien 3 Transcatheter Heart Valve
- Keywords
- Aortic valve stenosis, Transcatheter aortic valve implantation, Transcatheter aortic valve replacement, Randomized controlled trial
- Medical subject headings
- Aortic Valve Stenosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Symetis ACURATE neo/TF transfemoral TAVI systemDevice
Transcatheter aortic valve implantation of a Symetis ACURATE neo/TF bioprosthesis by transfemoral access, pre-dilatation mandatory.
Edwards Sapien 3 Transcatheter Heart ValveDevice
Transcatheter aortic valve implantation of an Edwards Sapien 3 bioprosthesis by transfemoral access.
| Study group | Role | What they receive |
|---|---|---|
| Symetis ACURATE neo/TF transfemoral TAVI system | Active comparator | Symetis ACURATE neo/TF transfemoral TAVI system: self-expandable transcatheter aortic bioprosthesis, support frame made of nitinol, supra-annular processed trileaflet porcine pericardial valve and an outer skirt to mitigate paravalvular regurgitation (manufactured by Symetis SA, Ecublens, Switzerland) Receives: Device: Symetis ACURATE neo/TF transfemoral TAVI system |
| Edwards Sapien 3 Transcatheter Heart Valve | Active comparator | Edwards SAPIEN 3 Transcatheter Heart Valve system: balloon-expandable transcatheter aortic bioprosthesis, support frame made of cobalt-chromium, three leaflets constructed of processed bovine pericardial tissue and an outer polyethylene terephthalate (PET) sealing cuff to mitigate paravalvular regurgitation (manufactured by Edwards Lifesciences, Inc., Irvine, California, USA) Receives: Device: Edwards Sapien 3 Transcatheter Heart Valve |
What is being measured
The primary outcome is the main question the study is designed to answer.
Modified* combined early safety and clinical efficacy as defined by the Valve Academic Research Consortium-2 (VARC-2)
(* "NYHA class III or IV" is omitted due to lack of objectiveness in its ascertainment)
- All-cause mortality
- All stroke (disabling and non-disabling)
- Life-threatening or disabling bleeding
- Acute kidney injury (stage 2 or 3, including renal replacement therapy)
- Coronary artery obstruction requiring intervention
- Major vascular complication
- Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention)
- Rehospitalization for valve-related symptoms or worsening congestive heart failure
- Valve-related dysfunction: prosthetic aortic valve stenosis (mean gradient ≥ 20 mmHg, effective orifice area ≤ 0.9-1.1cm2 and/or Doppler velocity index < 0.35) AND/OR ≥ moderate prosthetic valve regurgitation)
Measured: 30 days
Secondary outcomes (20)
Device success
Combined endpoint composed of:
- Absence of procedural mortality AND
- Correct positioning of a single prosthetic heart valve into the proper anatomical location AND
- Intended performance of the prosthetic heart valve (no prosthesis-patient mismatch and mean aortic valve gradient < 20 mmHg or peak velocity < 3 m/s, AND no moderate or severe prosthetic valve regurgitation)
Measured: 30 days
Early safety
Combined endpoint composed of:
- All-cause mortality
- All stroke (disabling and non-disabling)
- Life-threatening or disabling bleeding
- Acute kidney injury - stage 2 or 3 (including renal replacement therapy)
- Coronary artery obstruction requiring intervention
- Major vascular complication
- Valve-related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI, or SAVR)
Measured: 30 days
Clinical efficacy
Combined endpoint composed of:
- All-cause mortality
- All stroke (disabling and non-disabling)
- Requiring hospitalizations for valve-related symptoms or worsening congestive heart failure
- NYHA class III or IV
- Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, effective orifice area (EOA) ≤ 0.9-1.1 cm2 and/or Doppler velocity index (DVI) < 0. 35 m/s, AND/OR moderate or severe prosthetic valve regurgitation)
Measured: 30 days
Time-related valve safety
Combined endpoint composed of:
- Structural valve deterioration (Valve-related dysfunction (mean aortic valve gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1 cm2 (depending on body surface area (BSA)) and/or DVI < 0.35 m/s AND/OR moderate or severe prosthetic valve regurgitation)) OR Requiring repeat procedure (TAVI or SAVR)
- Prosthetic valve endocarditis
- Prosthetic valve thrombosis
- Thrombo-embolic events (e.g. stroke)
- VARC bleeding, unless clearly unrelated to valve therapy (e.g. trauma)
Measured: 30 days, 1 year
All-cause mortality
Measured: 30 days, 1 year, 3 years
All stroke (disabling and non-disabling)
Measured: 30 days, 1 year, 3 years
Life-threatening or disabling bleeding
- Fatal bleeding (Bleeding Academic Research Consortium (BARC) type 5)OR
- Bleeding in a critical organ, such as intracranial, intraspinal, intraocular, or pericardial necessitating pericardiocentesis, or intramuscular with compartment syndrome (BARC type 3b and 3c) OR
- Bleeding causing hypovolaemic shock or severe hypotension requiring vasopressors or surgery (BARC type 3b) OR
- Overt source of bleeding with drop in haemoglobin ≥5 g/dL or whole blood or packed red blood cells (RBCs) transfusion ≥4 units (BARC type 3b)
Measured: 30 days, 1 year, 3 years
Acute kidney injury (stage 2 or 3, including renal replacement therapy)
- Stage 2: Increase in serum creatinine to 200-299% (2.0-2.99 × increase compared with baseline) OR Urine output <0.5 mL/kg/h for >12 but <24 h
- Stage 3: Increase in serum creatinine to ≥300% (>3 × increase compared with baseline) OR serum creatinine of ≥4.0 mg/dL (≥354 mmol/L) with an acute increase of at least 0.5 mg/dL (44 mmol/L) OR Urine output <0.3 ml/kg/h for ≥24 h OR Anuria for ≥12 h Notes: The increase in creatinine must occur within 48 h. Patients receiving renal replacement therapy are considered to meet Stage 3 criteria irrespective of other criteria.
Measured: 30 days, 1 year, 3 years
Coronary artery obstruction requiring intervention
Measured: 30 days, 1 year, 3 years
Major vascular complication
- Aortic dissection, aortic rupture, annulus rupture, left ventricle perforation, or new apical aneurysm/pseudo-aneurysm OR
- Access-related vascular injury (dissection, stenosis, perforation, rupture, arterio-venous fistula, pseudoaneurysm, haematoma, irreversible nerve injury, compartment syndrome, percutaneous closure device failure) leading to death, life-threatening or major bleeding, visceral ischaemia, or neurological impairment OR
- Distal embolization (non-cerebral) from a vascular source requiring surgery or resulting in amputation or irreversible end-organ damage OR
- Use of unplanned endovascular or surgical intervention associated with death, major bleeding, visceral ischaemia or neurological impairment OR
- Any new ipsilateral lower extremity ischaemia documented by patient symptoms, physical exam, and/or decreased or absent blood flow on lower extremity angiogram OR
- Surgery for access site-related nerve injury OR
- Permanent access site-related nerve injury
Measured: 30 days, 1 year, 3 years
Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention)
Measured: 30 days, 1 year, 3 years
Rehospitalization for valve-related symptoms or worsening congestive heart failure
Measured: 30 days, 1 year, 3 years
Valve-related dysfunction: prosthetic aortic valve stenosis AND/OR ≥ moderate prosthetic valve regurgitation
Prosthetic aortic valve stenosis: mean gradient ≥ 20 mmHg, EOA ≤ 0.9-1.1cm2 and/or DVI < 0.35)
Measured: 30 days, 1 year, 3 years
Conversion to open heart surgery
Measured: procedural
Annular rupture
Measured: procedural
New pacemaker implantation
Measured: 30 days, 1 year, 3 years
Valve thrombosis
Any thrombus attached to or near an implanted valve that occludes part of the blood flow path, interferes with valve function, or is sufficiently large to warrant treatment. Note that valve-associated thrombus identified at autopsy in a patient whose cause of death was not valve-related should not be reported as valve thrombosis.
Measured: 30 days, 1 year, 3 years
Mean trans-prosthetic aortic gradient
Measured: 30 days, 1 year, 3 years
Aortic regurgitation
Measured: 30 days, 1 year, 3 years
Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score
Measured: 30 days, 1 year, 3 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Jan 2017 (estimated)
- Study start8 Feb 2017
- Primary completion2 May 2019
- Study completion16 Feb 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Aortic Valve StenosisStudies of the same condition, open and under way.
- More trials run by Insel Gruppe AG, University Hospital BernThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 739 participants (actual)
Sponsor and investigators
- Lead sponsor
- Insel Gruppe AG, University Hospital Bern
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Thomas Pigrim, Prof. MD, Principal investigator, Bern University Hospital, Dep. of Cardiology, 3010 Bern, Switzerland
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03011346
- Sponsor's protocol ID
- V 4.0, 13.08.2018
- Acronym
- SCOPE I
- Status last verified
- Mar 2022
- First submitted
- 2 Jan 2017
- Last updated
- 10 Mar 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Lanz J, Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Stortecky S, Heg D, Juni P, Windecker S, Pilgrim T; SCOPE I investigators. Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial. Lancet. 2019 Nov 2;394(10209):1619-1628. doi: 10.1016/S0140-6736(19)32220-2. Epub 2019 Sep 27.
PubMed 31570258Tomii D, Lanz J, Heg D, Cozzi O, Thiele H, Kim WK, Joner M, Conradi L, Toggweiler S, Prendergast B, Windecker S, Pilgrim T; SCOPE I Investigators. Sex-Specific Differences in Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement. JACC Adv. 2026 Aug 13:103175. doi: 10.1016/j.jacadv.2026.103175. Online ahead of print.
PubMed 42663370Tomii D, Lanz J, Heg D, Thiele H, Kim WK, Joner M, Mollmann H, Conradi L, Thilo C, Toggweiler S, Prendergast B, Windecker S, Pilgrim T; SCOPE I Investigators. Relationship between baseline patient-reported health status and patient-centered outcomes after transcatheter aortic valve replacement. Am Heart J. 2026 Oct;300:107495. doi: 10.1016/j.ahj.2026.107495. Epub 2026 May 26.
PubMed 42203165Tomii D, Lanz J, Thiele H, Heg D, Kim WK, Joner M, Mollmann H, Burgdorf C, Linke A, Redwood S, Hilker M, Conradi L, Kerber S, Thilo C, Toggweiler S, Walther T, Prendergast B, Windecker S, Pilgrim T. Obstructive Coronary Artery Disease and Health Status in Transcatheter Aortic Valve Replacement: A Post Hoc Analysis of the SCOPE I Randomized Clinical Trial. JAMA Netw Open. 2025 Dec 1;8(12):e2547111. doi: 10.1001/jamanetworkopen.2025.47111.
PubMed 41364435Lanz J, Mollmann H, Kim WK, Burgdorf C, Linke A, Redwood S, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Thilo C, Toggweiler S, Prendergast B, Husser O, Stortecky S, Deckarm S, Kunzi A, Heg D, Walther T, Windecker S, Pilgrim T; SCOPE I Investigators. Final 3-Year Outcomes of a Randomized Trial Comparing a Self-Expanding to a Balloon-Expandable Transcatheter Aortic Valve. Circ Cardiovasc Interv. 2023 Jul;16(7):e012873. doi: 10.1161/CIRCINTERVENTIONS.123.012873. Epub 2023 Jul 7.
PubMed 37417229Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Blumenstein J, Stortecky S, Heg D, Kunzi A, Juni P, Windecker S, Pilgrim T, Lanz J; SCOPE I Investigators. One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a Balloon-Expandable Transcatheter Aortic Valve. Circulation. 2021 Mar 23;143(12):1267-1269. doi: 10.1161/CIRCULATIONAHA.120.052251. Epub 2021 Mar 22. No abstract available.
PubMed 33750210
Study at a glance
From the registry record, last updated by the sponsor on 10 Mar 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach.
- ClinicalTrials.gov ID
- NCT03011346
- Acronym / sponsor ID
- SCOPE I / V 4.0, 13.08.2018
- Conditions
- Aortic Valve Stenosis
- Keywords
- Aortic valve stenosis, Transcatheter aortic valve implantation, Transcatheter aortic valve replacement, Randomized controlled trial
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 739 participants (actual)
- Lead sponsor
- Insel Gruppe AG, University Hospital BernUniversity, hospital or other
- Study start
- 8 Feb 2017 (actual)
- Primary completion
- 2 May 2019 (actual)
- Study completion
- 16 Feb 2022 (actual)
- First posted
- 5 Jan 2017 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). Many novel devices are currently being developed and established transcatheter heart valves undergo design reiterations to address limitations and reduce complication rates associated with the device and implantation procedure. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves. The aim of this study is to assess non-inferiority of the self-expandable Symetis ACURATE neo/TF in comparison to the balloon-expandable Edwards SAPIEN 3 transcatheter aortic valve bioprosthesis with regard to early safety and clinical efficacy at 30 days.
Detailed description
Background:
Transcatheter aortic valve implantation (TAVI) is an established and valuable treatment option for patients with severe symptomatic aortic stenosis and at increased risk for surgical aortic valve replacement (SAVR). The use of TAVI is rapidly expanding worldwide and the indications for TAVI are widening into lower risk populations in view of favorable outcomes among high and intermediate risk patients. Many novel devices are currently developed or established devices undergo design reiterations to address limitations, such as vascular access complications, paravalvular regurgitation, and atrio-ventricular conductance disturbances. However, device comparisons by use of randomized trials are scarce in particular for newer generation transcatheter valves.
The Symetis ACURATE neo/TF, a self-expandable transcatheter valve delivered via transfemoral access, gained Conformité Européenne (CE) marking in September 2014 after showing favorable procedural and short term results. The SCOPE I trial will compare its performance to the balloon-expandable Edwards SAPIEN 3, a widely used and well-established transcatheter heart valve of the second generation, in a randomized fashion.
Objectives:
The primary objective is the comparison of the Symetis ACURATE neo/TF to the Edwards SAPIEN 3 transcatheter aortic bioprosthesis with regard to early safety and clinical efficacy at 30 days. Secondary objectives involve the comparison between the two devices with regard to secondary clinical and echocardiographic endpoints at 30 days, 1 year and 3 years.
Methods:
Sample Size: Based on an anticipated incidence proportion of 22% for the primary non-hierarchical composite endpoint at 30 days in both treatment arms, a non-inferiority margin of 7.7%, a power of 80%, a one-tailed significance level of α = 0.05, and a low attrition rate, the total required sample size amounts to 730 patients.
Design: Patients will be allocated to the Symetis ACURATE neo/TF or the Edwards SAPIEN 3 bioprosthesis at a 1:1 ratio by means of a randomly permuted block randomisation stratified on study center and Society of Thoracic Surgeons' predicted risk of mortality score (STS-PROM) strata (< 3%, ≥ 3 to < 8%, ≥ 8%).
Analysis: Estimates of the risk-differences between the two treatment arms with regard to the primary endpoint will be pooled over the predefined STS-PROM strata by means of the Cochran-Mantel-Haenszel method and Wald-type confidence limits will be calculated using the Sato variance estimator. The non-inferiority assumption will be tested at a one-sided significance level with a type I error rate (α) = 0.05. The analysis of the primary composite endpoint will be conducted according to the intention-to-treat (ITT) and the per protocol (PP) principle and non-inferiority should be claimed only if met by both.
In case non-inferiority is established, a superiority analysis will be performed using a two-tailed significance level with a type I error rate of α = 0.05. Further secondary analyses will evaluate between group differences in relation to demographic, clinical, procedural, functional and imaging characteristics. Pre-specified subgroup analyses will be conducted by use of appropriate interaction tests contrasting categories of sex, STS-PROM score (< 3%, ≥ 3 to < 8%, ≥ 8%), left ventricular ejection fraction (< 50% vs. ≥ 50%), and native aortic valve eccentricity index (≤ 0.25 vs. > 0.25).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Symetis ACURATE neo/TF transfemoral TAVI system | Active comparator | Device: Symetis ACURATE neo/TF transfemoral TAVI systemSymetis ACURATE neo/TF transfemoral TAVI system: self-expandable transcatheter aortic bioprosthesis, support frame made of nitinol, supra-annular processed trileaflet porcine pericardial valve and an outer skirt to mitigate paravalvular regurgitation (manufactured by Symetis SA, Ecublens, Switzerland) |
| Edwards Sapien 3 Transcatheter Heart Valve | Active comparator | Device: Edwards Sapien 3 Transcatheter Heart ValveEdwards SAPIEN 3 Transcatheter Heart Valve system: balloon-expandable transcatheter aortic bioprosthesis, support frame made of cobalt-chromium, three leaflets constructed of processed bovine pericardial tissue and an outer polyethylene terephthalate (PET) sealing cuff to mitigate paravalvular regurgitation (manufactured by Edwards Lifesciences, Inc., Irvine, California, USA) |
Who may qualify
- Ages
- 75 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (11 listed)
- Patient with severe aortic stenosis defined by an aortic valve area (AVA) < 1cm2 or AVA indexed to body surface area (BSA) of < 0.6 cm2/m2, including low-flow severe aortic stenosis defined by stroke volume index (SVI) < 35ml/m2, as assessed by integration of echocardiographic and invasive measurements
- Subject is symptomatic (heart failure symptoms with New York Heart Association (NYHA) Functional Class > I, angina or syncope)
- Patient is considered at increased risk for mortality if undergoing conventional surgical aortic valve replacement or judged as not operable as determined either
- The heart team agrees on eligibility of the patient for participation and that TAVI by transfemoral access constitutes the most appropriate treatment modality, from which the patient will likely benefit most
- Aortic annulus dimensions suitable for both valve types (area range: 338-573 mm2 AND perimeter range: 66-85 mm) based on ECG-gated multislice computed tomographic measurements. Findings of transesophageal echocardiography (TEE) and conventional aortography should be integrated in the anatomic assessment if available
Key exclusion criteria (19 listed)
- Non-valvular aortic stenosis
- Congenital aortic stenosis or unicuspid or bicuspid aortic valve
- Non-calcific acquired aortic stenosis
- Anatomy not appropriate for transfemoral transcatheter aortic valve implantation due to size of the aortic annulus or degree or eccentricity of calcification of the native aortic valve or tortuosity of the aorta or ilio-femoral arteries
- Emergency procedure including patients in cardiogenic shock (low cardiac output, vasopressor dependence, mechanical hemodynamic support)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Symetis ACURATE neo/TF transfemoral TAVI systemTranscatheter aortic valve implantation of a Symetis ACURATE neo/TF bioprosthesis by transfemoral access, pre-dilatation mandatory. | Device | Symetis ACURATE neo/TF transfemoral TAVI system |
| Edwards Sapien 3 Transcatheter Heart ValveTranscatheter aortic valve implantation of an Edwards Sapien 3 bioprosthesis by transfemoral access. | Device | Edwards Sapien 3 Transcatheter Heart Valve |
Primary outcome
Modified* combined early safety and clinical efficacy as defined by the Valve Academic Research Consortium-2 (VARC-2)
Time frame: 30 days
(* "NYHA class III or IV" is omitted due to lack of objectiveness in its ascertainment) * All-cause mortality * All stroke (disabling and non-disabling) * Life-threatening or disabling bleeding * Acute kidney injury (stage 2 or 3, including renal replacement therapy) * Coronary artery obstruction requiring intervention * Major vascular complication * Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention) * Rehospitalization for valve-related symptoms or worsening congestive heart failure * Valve-related dysfunction: prosthetic aortic valve stenosis (mean gradient ≥ 20 mmHg, effective orifice area ≤ 0.9-1.1cm2 and/or Doppler velocity index < 0.35) AND/OR ≥ moderate prosthetic valve regurgitation)
20 secondary outcomes
Device success
Time frame: 30 days
Early safety
Time frame: 30 days
Clinical efficacy
Time frame: 30 days
Time-related valve safety
Time frame: 30 days, 1 year
All-cause mortality
Time frame: 30 days, 1 year, 3 years
All stroke (disabling and non-disabling)
Time frame: 30 days, 1 year, 3 years
Life-threatening or disabling bleeding
Time frame: 30 days, 1 year, 3 years
Acute kidney injury (stage 2 or 3, including renal replacement therapy)
Time frame: 30 days, 1 year, 3 years
Coronary artery obstruction requiring intervention
Time frame: 30 days, 1 year, 3 years
Major vascular complication
Time frame: 30 days, 1 year, 3 years
Valve related dysfunction requiring repeat procedure (balloon aortic valvuloplasty, TAVI or SAVR in a separate intervention)
Time frame: 30 days, 1 year, 3 years
Rehospitalization for valve-related symptoms or worsening congestive heart failure
Time frame: 30 days, 1 year, 3 years
Valve-related dysfunction: prosthetic aortic valve stenosis AND/OR ≥ moderate prosthetic valve regurgitation
Time frame: 30 days, 1 year, 3 years
Conversion to open heart surgery
Time frame: procedural
Annular rupture
Time frame: procedural
New pacemaker implantation
Time frame: 30 days, 1 year, 3 years
Valve thrombosis
Time frame: 30 days, 1 year, 3 years
Mean trans-prosthetic aortic gradient
Time frame: 30 days, 1 year, 3 years
Aortic regurgitation
Time frame: 30 days, 1 year, 3 years
Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score
Time frame: 30 days, 1 year, 3 years
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Mar 2022.
- Results publication: PubMed 31570258Lanz J, Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Stortecky S, Heg D, Juni P, Windecker S, Pilgrim T; SCOPE I investigators. Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial. Lancet. 2019 Nov 2;394(10209):1619-1628. doi: 10.1016/S0140-6736(19)32220-2. Epub 2019 Sep 27.
- Derived from this study: PubMed 42663370Tomii D, Lanz J, Heg D, Cozzi O, Thiele H, Kim WK, Joner M, Conradi L, Toggweiler S, Prendergast B, Windecker S, Pilgrim T; SCOPE I Investigators. Sex-Specific Differences in Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement. JACC Adv. 2026 Aug 13:103175. doi: 10.1016/j.jacadv.2026.103175. Online ahead of print.
- Derived from this study: PubMed 42203165Tomii D, Lanz J, Heg D, Thiele H, Kim WK, Joner M, Mollmann H, Conradi L, Thilo C, Toggweiler S, Prendergast B, Windecker S, Pilgrim T; SCOPE I Investigators. Relationship between baseline patient-reported health status and patient-centered outcomes after transcatheter aortic valve replacement. Am Heart J. 2026 Oct;300:107495. doi: 10.1016/j.ahj.2026.107495. Epub 2026 May 26.
- Derived from this study: PubMed 41364435Tomii D, Lanz J, Thiele H, Heg D, Kim WK, Joner M, Mollmann H, Burgdorf C, Linke A, Redwood S, Hilker M, Conradi L, Kerber S, Thilo C, Toggweiler S, Walther T, Prendergast B, Windecker S, Pilgrim T. Obstructive Coronary Artery Disease and Health Status in Transcatheter Aortic Valve Replacement: A Post Hoc Analysis of the SCOPE I Randomized Clinical Trial. JAMA Netw Open. 2025 Dec 1;8(12):e2547111. doi: 10.1001/jamanetworkopen.2025.47111.
- Derived from this study: PubMed 37417229Lanz J, Mollmann H, Kim WK, Burgdorf C, Linke A, Redwood S, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Thilo C, Toggweiler S, Prendergast B, Husser O, Stortecky S, Deckarm S, Kunzi A, Heg D, Walther T, Windecker S, Pilgrim T; SCOPE I Investigators. Final 3-Year Outcomes of a Randomized Trial Comparing a Self-Expanding to a Balloon-Expandable Transcatheter Aortic Valve. Circ Cardiovasc Interv. 2023 Jul;16(7):e012873. doi: 10.1161/CIRCINTERVENTIONS.123.012873. Epub 2023 Jul 7.
- Derived from this study: PubMed 33750210Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Blumenstein J, Stortecky S, Heg D, Kunzi A, Juni P, Windecker S, Pilgrim T, Lanz J; SCOPE I Investigators. One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a Balloon-Expandable Transcatheter Aortic Valve. Circulation. 2021 Mar 23;143(12):1267-1269. doi: 10.1161/CIRCULATIONAHA.120.052251. Epub 2021 Mar 22. No abstract available.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Thomas Pigrim, Prof. MD principal investigator
Bern University Hospital, Dep. of Cardiology, 3010 Bern, Switzerland
20 sites in 4 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Symetis ACURATE neo/TF transfemoral TAVI system and Edwards Sapien 3 Transcatheter Heart Valve in people with Aortic Valve Stenosis, run by Insel Gruppe AG, University Hospital Bern at 20 sites in 4 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 11 inclusion and 19 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 10 Mar 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 20 sites in Germany, Switzerland, Netherlands, United Kingdom. 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
Modified* combined early safety and clinical efficacy as defined by the Valve Academic Research Consortium-2 (VARC-2) (time frame: 30 days). 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 NCT03011346, which also lists 6 linked publications.
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 10 Mar 2022.