The objective of the study is to assess the safety and effectiveness of the BD Liverty™ TIPS Stent Graft for the treatment of the complications of portal hypertension from cirrhosis. This includes recurrent or refractory ascites, hepatic hydrothorax, and/or variceal bleeding (esophageal and/or gastric).
This is a prospective, multi-center, single-arm study designed to assess the safety and effectiveness of the BD Liverty™ TIPS Stent Graft for the treatment of the complications of portal hypertension. Safety and effectiveness measures for subjects receiving the BD Liverty™ TIPS Stent Graft will be compared to a Performance Goal (PG) derived from published literature.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
177
Treatment of portal hypertension complications with placement of the BD Liverty™ TIPS Stent Graft after creation of a Transjugular Intrahepatic Portosystemic Shunt.
Freedom from Major Complications through 30 days post-Index Procedure
The primary safety endpoint is Freedom from Major Complications through 30 days post-Index Procedure. Major complications are defined as: The following Adverse Events (if determined to be related to the device and/or procedure and to meet the definition of a Serious Adverse Event (SAE)): * Accelerated Liver Failure * Biliary Peritonitis * Caval Occlusion * Death * Hemobilia * Hemoperitoneum * Hepatic Artery Injury * Hepatic Infarction * Radiation Skin Burn * Renal Failure * Severe Hepatic Encephalopathy * Vascular Perforation (resulting from stent graft malposition due to excessive extension of the stent graft into the inferior vena cava or the right atrium) The following Device Deficiencies, if having the potential to or if confirmed to have led to a Serious Adverse Event (SAE): o Stent Migration (within the portal or systemic venous circulations resulting from stent graft malposition)
Time frame: 30 days
Freedom from Shunt Dysfunction through 6 months post-Treatment Completion
The primary effectiveness endpoint is Freedom from Shunt Dysfunction through 6-months post-Treatment Completion. Shunt Dysfunction is defined as the proportion of subjects free from both a \>50% reduction of the lumen of the stent (confirmed by direct shunt venography for subjects with suspected shunt dysfunction) and a PSG greater than the PSG achieved post-TIPS Index Procedure. Treatment Completion is defined as the latter to occur of (i) completion of the Index Procedure and (ii) if performed, the Tailored Expansion Procedure (TEP).
Time frame: 6 months
Technical Success
Technical Success, defined as the successful creation of a BD Liverty™ TIPS Stent Graft lined shunt between the hepatic vein and a branch of the portal vein, as assessed by the Investigator during the Index Procedure.
Time frame: Index Procedure
Hemodynamic Success
Hemodynamic Success, defined as the successful post-TIPS reduction of the portosystemic gradient (PSG) to an Investigator-determined target of ≤12 mmHg or by ≥50% from the baseline PSG, as assessed by the Investigator during the Index Procedure.
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Stanford University
Palo Alto, California, United States
Georgetown University
Washington D.C., District of Columbia, United States
Trustees of Indiana University ("IU")/ Indiana University Health, Inc.
Indianapolis, Indiana, United States
University of Kansas Medical Center Research Institute, Inc.
Kansas City, Kansas, United States
The General Hospital Corporation d/b/a Massachusetts General Hospital
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center, Inc.
Boston, Massachusetts, United States
Washington University - Mallinckrodt Institute of Radiology
St Louis, Missouri, United States
Rutgers, The State University of New Jersey
Newark, New Jersey, United States
Icahn School of Medicine at Mount Sinai
New York, New York, United States
The Trustees of Columbia University in the City of New York
New York, New York, United States
...and 16 more locations
Time frame: Index Procedure
Clinical Success for subjects with Recurrent or Refractory Ascites
Clinical Success for subjects with recurrent or refractory ascites through 3, 6, 12, 18, and 24 months post-Treatment Completion, defined as freedom from large volume paracentesis (LVP) of \>5L occurring \>6 weeks post-Treatment Completion.
Time frame: 3, 6, 12, 18, and 24 months post-Treatment Completion
Clinical Success for subjects with Hepatic Hydrothorax
Clinical Success for subjects with hepatic hydrothorax through 3, 6, 12, 18, and 24 months post-Treatment Completion, defined as freedom from thoracentesis of \>1L occurring \>6 weeks post-Treatment Completion.
Time frame: 3, 6, 12, 18, and 24 months post-Treatment Completion
Clinical Success for subjects with Esophagogastric Variceal Re-Bleeding
Clinical Success for subjects with esophagogastric variceal bleeding through 1, 3, 6, 12, 18, and 24 months post-Treatment Completion, defined as freedom from endoscopically-confirmed esophagogastric variceal re-bleeding.
Time frame: 3, 6, 12, 18, and 24 months post-Treatment Completion
Freedom from Shunt Re-Intervention
Freedom from Shunt Re-Intervention through 1, 3, 6, 12, 18, and 24 months post-Treatment Completion.
Time frame: 1, 3, 6, 12, 18, and 24 months post-Treatment Completion
Freedom from Hepatic Encephalopathy of Grade ≥3 per West Haven Criteria
Freedom from Hepatic Encephalopathy of Grade ≥3 per West Haven Criteria through 1, 3, 6, 12, 18, and 24 months post-Treatment Completion.
Time frame: 1, 3, 6, 12, 18, and 24 months post-Treatment Completion
Liver Transplant-Free Survival
Liver Transplant-Free Survival post-Index Procedure, defined as the proportion of subjects with freedom from death from any cause and from liver transplantation.
Time frame: Through 24 months
Overall Survival
Overall Survival post-Index Procedure, defined as the proportion of subjects with freedom from death from any cause.
Time frame: Through 24 months
Health-Related Quality of Life (HRQoL) Questionnaire
Health-Related Quality of Life (HRQoL) at Screening and at 1, 3, 6, 12, 18, and 24 months post-Treatment Completion, as measured by PROMIS-29 Profile v2.1.
Time frame: 1, 3, 6, 12, 18, and 24 months post-Treatment Completion
Freedom from Shunt Dysfunction
Freedom from Shunt Dysfunction through 1, 3, 12, 18, and 24 months post-Treatment Completion. Shunt Dysfunction is defined as the proportion of subjects free from both a \>50% reduction of the lumen of the stent (confirmed by direct shunt venography for subjects with suspected shunt dysfunction) and a PSG greater than the PSG achieved post-TIPS Index Procedure.
Time frame: 1, 3, 12, 18, and 24 months post-Treatment Completion