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Transcatheter Aortic Valve Replacement With the Medtronic Transcatheter Aortic Valve Replacement System In Patients at Low Risk for Surgical Aortic Valve Replacement

Description

Brief Summary
The study objective is to demonstrate that the safety and effectiveness of the Medtronic TAVR system as measured by rates of all-cause mortality or disabling stroke at two years is noninferior to SAVR in the treatment of severe aortic stenosis in subjects who have a low predicted risk of operative mortality for SAVR.


Detailed Description
Multi-center, international, prospective, randomized, interventional, pre-market. Subjects will be randomized on 1:1 basis to either TAVR with the Medtronic TAVR system or to SAVR. Patients will be seen at pre and post-procedure, discharge, 30 days, 6 months, 1 year, 18 months, and annually through 5 years

Phase

N/A

Inclusion and Exclusion Criteria

  • Severe aortic stenosis, defined as follows:
  • For symptomatic patients: Aortic valve area ≤ 1.0 cm2 (or aortic valve area index of ≤ 0.6 cm2/m2), OR mean gradient ≥ 40 mmHg, OR Maximal aortic valve velocity ≥ 4.0 m/sec by echocardiography or cardiac catheterization
  • For asymptomatic patients: i. Very severe aortic stenosis with an aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2) AND maximal aortic velocity ≥ 5.0 m/sec by echocardiography or cardiac catheterization, OR ii. Aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2) by the continuity equation, AND a mean gradient ≥ 40 mmHg, or maximal aortic valve velocity ≥ 4.0 m/sec by echocardiography or cardiac catheterization, AND an exercise tolerance test that demonstrates a limited exercise capacity, abnormal BP response, or arrhythmia.
  • Documented heart team agreement of low risk for SAVR, where low risk is defined as predicted risk of mortality for SAVR < 3% at 30 days
  • The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.

  • Any condition considered a contraindication for placement of a bioprosthetic valve (e.g. subject is indicated for mechanical prosthetic valve).
  • A known hypersensitivity or contraindication to any of the following that cannot be adequately premedicated:
  • aspirin or heparin (HIT/HITTS) and bivalirudin
  • ticlopidine and clopidogrel
  • Nitinol (titanium or nickel)
  • contrast media
  • Leukopenia (WBC < 1000 mm3), thrombocytopenia (platelet count <50,000 cells/mm3), history of bleeding diathesis or coagulopathy, or hypercoagulable states.
  • Ongoing sepsis, including active endocarditis.
  • Any percutaneous coronary or peripheral interventional procedure with a bare metal or drug eluting stent performed within 180 days prior to randomization.
  • Multivessel coronary artery disease with a Syntax score > 22 and/or unprotected left main coronary artery.
  • Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 10 weeks of Heart Team assessment.
  • Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or mechanical hemodynamic support.
  • Recent (within 2 months of Heart Team assessment) cerebrovascular accident (CVA) or transient ischemic attack (TIA).
  • Gastrointestinal (GI) bleeding that would preclude anticoagulation.
  • Subject refuses a blood transfusion.
  • Severe dementia
  • Estimated life expectancy of less than 24 months due to associated non-cardiac co-morbid conditions.
  • Other medical, social, or psychological conditions that in the opinion of the investigator precludes the subject from appropriate consent or adherence to the protocol required follow-up exams.
  • Currently participating in an investigational drug or another device trial (excluding registries).
  • Evidence of an acute myocardial infarction ≤ 30 days before the trial procedure due to unstable coronary artery disease
  • Need for emergency surgery for any reason.
  • Subject is pregnant or breast feeding.
  • Pre-existing prosthetic heart valve in any position.
  • Severe mitral regurgitation amenable to surgical replacement or repair.
  • Severe tricuspid regurgitation amenable to surgical replacement or repair.
  • Moderate or severe mitral stenosis amenable to surgical replacement or repair.
  • Hypertrophic obstructive cardiomyopathy with left ventricular outflow gradient.
  • Bicuspid aortic valve verified by echocardiography, MDCT, or MRI.
  • Prohibitive left ventricular outflow tract calcification.
  • Sinus of Valsalva diameter unsuitable for placement of the self-expanding bioprosthesis.
  • Aortic annulus diameter of <18 or >29 mm.
  • Access vessel mean diameter < 5.0 mm for Evolut 23R, 26R, or 29R TAV, or <6.0 mm for patent LIMA, or access vessel mean diameter < 6.0 mm for CoreValve 31 mm TAV.

Sites

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