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Mitral RegurgitationMILLENNIALNCT06075823

Edge-to-edge Mitral Valve Repair in ATTR-CM

A study testing TEER and Optimal Medical Therapy in people with Mitral Regurgitation and ATTR-Cardiomyopathy, run by Medical University of Vienna at 10 sites in 3 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

No previous study has evaluated the effectiveness of transcatheter edge-to-edge mitral valve repair (TEER) in patients with ATTR-associated cardiomyopathy (ATTR-CM) and significant mitral regurgitation, as this specific patient population was specifically excluded from previous large TEER trials. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
TEER and Optimal Medical Therapy
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
106 participants
Where
10 sitesin 3 countries
Study dates
1 Jan 2024to 12 Dec 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • Proven ATTR-CM
  • Significant symptomatic MR (3+ or 4+ by independent echocardiographic core laboratory assessment)
  • Subject has been adequately treated per applicable standards, including for coronary artery disease and heart failure (e.g., diuretics)
  • New York Heart Association (NYHA) functional class II, III, or ambulatory IV
  • Local heart team has determined that mitral valve surgery will not be offered as a treatment option, even if the subject is randomized to the control group
  • Left ventricular ejection fraction ≥20%
Show all 9Show fewer
  • Anatomical feasibility for TEER as per discretion of the implanting investigator
  • Age 18 years or older
  • Subject or guardian agrees to all provisions of the protocol, including the possibility of randomization to the Control group and returning for all required post-procedure follow-up visits, and has provided written informed consent

Who cannot join

  • AL-associated cardiomyopathy
  • Aortic valve disease requiring surgery or transcatheter intervention
  • Severe right ventricular dysfunction
  • Hemodynamic instability requiring inotropic support or mechanical heart assistance
  • Leaflet anatomy which may preclude TEER, proper device positioning on the leaflets or sufficient reduction in mitral regurgitation by TEER
  • Life expectancy <12 months due to non-cardiac conditions
Show all 13Show fewer
  • Prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve, or any prior transcatheter mitral valve procedure
  • Echocardiographic evidence of intracardiac mass, thrombus or vegetation
  • Active endocarditis or active rheumatic heart disease or leaflets degenerated from rheumatic disease (i.e., noncompliant, perforated)
  • Active infections requiring current antibiotic therapy
  • Transesophageal echocardiography (TEE) is contraindicated or high risk
  • Pregnant or planning pregnancy within next 12 months
  • Currently participating in another investigational device study that has not reached its primary endpoint

Trial locations and contacts

10 sites in 3 countries. Contact the study team or a site near you to ask about taking part.

10 sites in 3 countries

Austria5 sites, 5 recruiting
  • Medical University of Graz, Division of Cardiology

    Graz

    Nicolas Verheyen, MD, nicolas.verheyen@medunigraz.at

    Recruiting
  • Ordensklinikum Linz Elisabethinen, Internal Medicine 2, Cardiology

    Linz

    Christian Ebner, MD, Christian.Ebner@ordensklinikum.at

    Recruiting
  • University Hospital St. Pölten, Department of Internal Medicine 3

    Sankt Pölten

    Julia Mascherbauer, MD, Julia.Mascherbauer@stpoelten.lknoe.at

    Recruiting
  • Clinic Favoriten, 5th Medical Department, Cardiology

    Vienna, 1090

    Diana Bonderman, MD, diana.bonderman@gesundheitsverbund.at

    Recruiting
  • Medical University of Vienna

    Vienna, 1090

    Christian Nitsche, MD, PhD, 01 40400 46142, christian.nitsche@meduniwien.ac.at

    Recruiting

Other trials in Austria

Germany3 sites, 3 recruiting
  • Hannover Medical School, Department of Cardiology and Angiology

    Hanover

    Dominik Berliner, MD, berliner.dominik@mh-hannover.de

    Not yet recruiting
  • University Hospital Heidelberg, Department of Cardiology, Angiology and Respiratory Medicine

    Heidelberg

    Mathias Konstandin, MD, Mathias.Konstandin@med.uni-heidelberg.de

    Recruiting
  • LMU University Hospital, Department of Medicine I

    München

    Jörg Hausleiter, MD, Joerg.Hausleiter@med.uni-muenchen.de

    Recruiting

Other trials in Germany

Italy2 sites, 2 recruiting
  • ASST Papa Giovanni XXIII, Cardiovascular Department

    Bergamo

    Edoardo Sciatti, MD, esciatti@asst-pg23.it

    Not yet recruiting
  • ASST Spedali Civili di Brescia, Cardiology

    Brescia

    Marianna Adamo, MD, mariannaadamo@hotmail.com

    Recruiting

Other trials in Italy

About this study

Official title: Effectiveness and Safety of Edge-to-edge MItral vaLve Repair in Patients With Significant mitraL rEgurgitatioN aNd cardIac ATTR amyLoidosis

No previous study has evaluated the effectiveness of transcatheter edge-to-edge mitral valve repair (TEER) in patients with ATTR-associated cardiomyopathy (ATTR-CM) and significant mitral regurgitation, as this specific patient population was specifically excluded from previous large TEER trials. From a pathophysiological perspective, effective treatment of significant regurgitant volume and consecutive improvement of forward volume appears highly desirable in a condition with intrinsically low output. However, whether this translates into improved functional capacity, better quality of life, and better clinical outcomes compared to conservative heart failure management alone remains to be investigated.

Read the detailed description

MILLENNIAL is an investigator-initiated, multicentre, prospective, parallel-group, open-label, randomized controlled trial. Patients with proven ATTR-CM and concomitant significant (moderate-to-severe or severe) symptomatic mitral regurgitation, in whom the local heart team has ruled out mitral valve surgery and who are anatomically suitable for TEER, are randomized 1:1 to TEER plus optimal medical therapy (OMT) or OMT alone. Randomization is performed centrally with permuted blocks of variable size (4-8), stratified by the presence of significant tricuspid regurgitation and NYHA class ≥III. ATTR-specific therapy is allowed in both arms at the discretion of the treating physician. Cross-over is not permitted within the first year.

The primary endpoint is a hierarchical composite assessed at 12 months, analysed with the Finkelstein-Schoenfeld method (win ratio as effect measure, stratified by National Amyloidosis Centre stage): (1) all-cause mortality, (2) cumulative frequency of unplanned cardiovascular hospitalizations, (3) change from baseline in 6-minute walk distance (win threshold ≥30 m), (4) change from baseline in KCCQ Overall Summary score (win threshold ≥5 points). Heart transplantation, combined heart-liver transplantation and durable mechanical circulatory support are counted as death. Change in NT-proBNP is the key secondary endpoint; technical, device and procedural success (MVARC) are safety endpoints. Exploratory endpoints include intraprocedural invasive haemodynamics before and after device deployment and advanced echocardiographic indices of myocardial performance.

A sample size of 106 patients (53 per arm) provides 80% power at a two-sided alpha of 0.05 for an assumed win ratio of 2.1, including 10% cross-over and 5% drop-out. Study visits take place at baseline, 6 months (±7 days) and 12 months (±14 days). Interim analyses are performed after every 25 patients and reviewed by an independent data monitoring committee; a pre-specified futility analysis is performed once 50 patients have completed 12-month follow-up (stop if conditional power <10%).

Being tested
TEER, Optimal Medical Therapy
Medical subject headings
Mitral Valve Insufficiency

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TEERDevice

    Transcatheter edge-to-edge mitral valve repair under general anaesthesia with transoesophageal echocardiographic and fluoroscopic guidance; up to three newer-generation MitraClip (NTR, XTR; Abbott) or PASCAL (Edwards Lifesciences) devices to maximally reduce mitral regurgitation. Intraprocedural invasive haemodynamic measurements before and after device deployment.

  • Optimal Medical TherapyOther

    Optimal medical therapy according to the current understanding of heart failure management in ATTR-CM (careful volume management, rate/rhythm control in atrial fibrillation, anticoagulation where indicated). ATTR-specific therapy (e.g. tafamidis, acoramidis) is allowed but not mandatory in both arms at the discretion of the treating physician; all heart failure and ATTR-specific medication is recorded at every visit.

Study groups in NCT06075823
Study groupRoleWhat they receive
InterventionalExperimentalTEER + Optimal Medical Therapy
Receives: Device: TEER; Other: Optimal Medical Therapy
ControlActive comparatorOptimal Medical Therapy alone
Receives: Other: Optimal Medical Therapy

What is being measured

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

  1. Hierarchical composite of all-cause mortality, cumulative frequency of unplanned cardiovascular-related hospitalizations, change from baseline in 6-minute walk distance, and change from baseline in KCCQ Overall Summary score through month 12

    Each subject in the TEER+OMT group is compared with each subject in the OMT group in a pairwise manner, within strata defined by National Amyloidosis Centre disease stage (I, II, III) at baseline, in hierarchical order: (1) all-cause mortality (heart transplantation, combined heart-liver transplantation and implantation of a durable mechanical cardiac-assist device count as death); (2) cumulative frequency of unplanned cardiovascular-related hospitalizations, compared over the shorter follow-up time of the pair; (3) change from baseline in 6-minute walk distance, a difference of ≥30 m defining a win (smaller differences are ties); (4) change from baseline in the Kansas City Cardiomyopathy Questionnaire Overall Summary score (0-100, higher = better health status), a difference of ≥5 points defining a win. Statistical significance is tested with the Finkelstein-Schoenfeld method at a two-sided alpha of 0.05; the win ratio quantifies the treatment effect.

    Measured: 12 months

Secondary outcomes (2)
  1. Change from baseline in NT-proBNP (key secondary endpoint)

    Change from baseline in N-terminal pro-B-type natriuretic peptide (pg/mL), analysed with a mixed-effects model for repeated measures / analysis of covariance with treatment group and visit as fixed effects and the baseline value as covariate.

    Measured: Baseline, 6 months and 12 months

  2. Technical, device, and procedural success of TEER (in the TEER group only)

    Technical, device, and procedural success of TEER as defined according to the definitions of the Mitral Valve Academic Research Consortium (MVARC)

    Measured: Technical success at exit from the procedure room; device and procedural success at 6 and 12 months

Timeline

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

  1. First posted10 Oct 2023
  2. Study start1 Jan 2024
  3. Primary completion12 Dec 2027 (estimated)
  4. Study completion12 Dec 2028 (estimated)

Resources

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
106 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06075823
Sponsor's protocol ID
1830/2023
Acronym
MILLENNIAL
Status last verified
Oct 2026
First submitted
27 Sep 2023
Last updated
16 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ; COAPT Investigators. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018 Dec 13;379(24):2307-2318. doi: 10.1056/NEJMoa1806640. Epub 2018 Sep 23.

    PubMed 30280640
  • Dona C, Nitsche C, Koschutnik M, Heitzinger G, Mascherbauer K, Kammerlander AA, Dannenberg V, Halavina K, Rettl R, Duca F, Traub-Weidinger T, Puchinger J, Gunacker PC, Lamm G, Vock P, Lileg B, Philipp V, Staudenherz A, Calabretta R, Hacker M, Agis H, Bartko P, Hengstenberg C, Fontana M, Goliasch G, Mascherbauer J. Unveiling Cardiac Amyloidosis, its Characteristics, and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair. JACC Cardiovasc Interv. 2022 Sep 12;15(17):1748-1758. doi: 10.1016/j.jcin.2022.06.009. Epub 2022 Aug 22.

    PubMed 36008266
  • Chacko L, Karia N, Venneri L, Bandera F, Passo BD, Buonamici L, Lazari J, Ioannou A, Porcari A, Patel R, Razvi Y, Brown J, Knight D, Martinez-Naharro A, Whelan C, Quarta CC, Manisty C, Moon J, Rowczenio D, Gilbertson JA, Lachmann H, Wechelakar A, Petrie A, Moody WE, Steeds RP, Potena L, Riefolo M, Leone O, Rapezzi C, Hawkins PN, Gillmore JD, Fontana M. Progression of echocardiographic parameters and prognosis in transthyretin cardiac amyloidosis. Eur J Heart Fail. 2022 Sep;24(9):1700-1712. doi: 10.1002/ejhf.2606. Epub 2022 Jul 27.

    PubMed 35779241
  • Nitsche C. Echocardiographic tracking of transthyretin cardiomyopathy: which parameters matter the most? Eur J Heart Fail. 2022 Sep;24(9):1713-1715. doi: 10.1002/ejhf.2639. Epub 2022 Aug 12. No abstract available.

    PubMed 35906799

Questions about this trial

What is this clinical trial studying?

A study testing TEER and Optimal Medical Therapy in people with Mitral Regurgitation and ATTR-Cardiomyopathy, run by Medical University of Vienna at 10 sites in 3 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 9 inclusion and 13 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: looking for participants now, as of the sponsor's last update on 16 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Austria, Germany, Italy. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Christian Nitsche, MD, PhD (0043 1 40400 46142, christian.nitsche@meduniwien.ac.at), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hierarchical composite of all-cause mortality, cumulative frequency of unplanned cardiovascular-related hospitalizations, change from baseline in 6-minute walk distance, and change from baseline in KCCQ Overall Summary score through month 12 (time frame: 12 months). 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 NCT06075823, which also lists 4 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 16 Oct 2026.

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Edge-to-edge Mitral Valve Repair in ATTR-CM | AzTrials