The goal of this Phase I Open-Label study is to demonstrate the safety and feasibility of VentriGel injection in children with Hypoplastic Left Heart Syndrome (HLHS). The main questions it aims to answer are: * Whether VentriGel is safe in treating patients with HLHS * Whether there are any preliminary improvements in measures of cardiac function following Ventrigel injection
HLHS, a type of congenital heart disease, presents a unique challenge where the left ventricle fails to develop, necessitating the right ventricle to manage both systemic and pulmonary blood flow. This condition, once fatal, has become manageable due to advancements in surgical techniques, with reported 5-year survival rates of 70-90%. However, these staged procedures, while lifesaving, can strain the right ventricle, leading to long-term issues such as weakened muscle and reduced cardiac function. Additionally, even with surgical intervention, patients often face a diminished quality of life. Addressing these challenges, ongoing clinical trials explore regenerative therapies, particularly stem cell injections, aiming to improve heart function. Yet, concerns persist regarding the practicality and efficacy of these treatments, including issues with cell survival and coordination of injections within narrow timeframes. Innovatively, the investigator and the team propose an alternative approach using VentriGel, an injectable hydrogel derived from decellularized porcine myocardium. Originally designed for treating heart failure post-myocardial infarction in adults, VentriGel has shown promising results in animal models, demonstrating significant improvements in cardiac function. Notably, its shelf-stable nature and flexible timing for administration offer advantages over traditional stem cell therapies. Moreover, VentriGel's effectiveness in addressing right-ventricular failure, as demonstrated in recent studies, highlights its potential as a solution for HLHS patients. Leveraging approved extracellular matrix devices, such as Alloderm and SurgiSIS, further underscores the feasibility and safety of this approach, paving the way for potentially transformative treatments in congenital heart diseases.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
VentriGel will be administered by injection into the right ventricle of the heart in the following defined doses per injection. There will be a total of 8 injections. The proposed dose of up to 0.6 mL is administered as up to 8 sequential injections of 4 injections of 0.1 mL each and 4 injections of 0.05 mL each.
Children's Healthcare of Altanta
Atlanta, Georgia, United States
Number of ventricular tachycardia events
Number of sustained/symptomatic ventricular tachycardia incidences requiring intervention with inotropic support or anti-arrhythmics
Time frame: upto 30 days post operation
Number of Cardiogenic shock events
Cardiogenic shock (i.e. tissue hypoperfusion presented by hypotension due to decreased cardiac output, determined by rising lactate levels (5x normal levels in first 24 hours, 2.5x normal levels in first 30 days)
Time frame: Day 1, 30 days post operation
Number of unplanned cardiovascular operation events
Unplanned cardiovascular operation due to right ventricular intramyocardial injection site bleeding in the first 5 days after Stage II operation decreased cardiac output, determined by rising lactate levels (5x normal levels in first 24 hours, 2.5x normal levels in first 30 days)
Time frame: 30 days post operation
Number of patients requiring new permanent pacemaker
Number of patients requiring new permanent pacemaker
Time frame: upto 30 days post operation
Stroke or embolic event
Stroke or embolic event to the brain determined by CT scan
Time frame: upto 30 days post operation
Number of Adverse Events
Number of adverse events occurring post op
Time frame: upto 30 days post operation
Number of deaths
Number of deaths occurring post op
Time frame: upto 30 days post operation
Number of VentriGel products manufactured and delivered to subjects
Time frame: 12 months
Number of patients receiving Cardiac MRIs
Time frame: Baseline, 6 months, 12 months
Change in right ventricular ejection fraction
This will be measured by serial echocardiograms and MRI scans
Time frame: Baseline, 6 months, 12 months post operation
Change in right ventricular end diastolic volume
This will be measured by serial echocardiograms and MRI scans
Time frame: Baseline, 6 months, 12 months post operation
Change in right ventricular end systolic volume
This will be measured by serial echocardiograms and MRI scans
Time frame: Baseline, 6 months, 12 months post operation
Change in tricuspid regurgitation
This will be measured by serial echocardiograms and MRI scans. tricuspid regurgitation measured by tricuspid valve vena contracta width
Time frame: Baseline, 6 months,12 months post operation
Change in right ventricular function Fractional Area Change
This will be measured by serial transthoracic echocardiogram (TTE)
Time frame: Baseline, 6 months,12 months post operation
Change in right ventricular global longitudinal strain
This will be measured by serial transthoracic echocardiogram (TTE)
Time frame: Baseline, 6 months,12 months post operation
Change in right ventricular global circumferential strain
This will be measured by serial transthoracic echocardiogram (TTE)
Time frame: Baseline, 6 months,12 months post operation
Change in right ventricular Tricuspid Annular Plane Systolic Excursion (TAPSE)
This will be measured by serial transthoracic echocardiogram (TTE)
Time frame: Baseline, 6 months,12 months post operation
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Change in right atrial volume indexed
This will be measured by serial transthoracic echocardiogram (TTE)
Time frame: Baseline, 6 months,12 months post operation