Safety, effectiveness and durability of Sapien 3 transcatheter aortic valve replacement in young aortic valve stenosis patients from China:A multi-center, retrospective and prospective, single arm, observational study
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis (AS). Currently TAVR indication has expanded to intermediate and low-risk patients from inoperable or high-risk patients, through a rigorous series of clinical trials comparing TAVR with surgical aortic valve replacement (SAVR). Despite 2020 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommended SAVR for patients with symptomatic severe AS aged \<65 years, the previous data from United States nationwide Vizient Clinical Data Base and Northern New England Cardiovascular Disease Group Consortium (NNECDSG) registry demonstrated dramatic growth in TAVR utilization in younger patients aged \<65 years from 2015 to 2021/2022, which is possibly driven by increased TAVR utilization in low surgical risk patients. However, TAVR has never been systematically tested in young (\<65 years old), low-risk patients, with many unanswered questions, especially the safety and effectiveness of TAVR in patients with bicuspid aortic valves and the durability of transcatheter heart valves. Furthermore, we noticed that the patients between 65 years old and 70 years old accounted for 23.3% of all the TAVR patients and this patient subgroup were underrepresented in the previous study, which makes it necessary to also explore the interested endpoints in this subgroup. The aim of this study is to establish the safety and efficacy of Sapien 3 TAVR in young (50\~70 years old) Chinese patients with severe symptomatic AS, including Type-1 bicuspid population and to explore the durability performance of Sapien 3 in this cohort.
Study Type
OBSERVATIONAL
Enrollment
450
TAVR procedure was performed according to standard clinical practice. Successful vascular access, delivery and deployment of the device and successful retrieval of the delivery system will be attempted. Vascular access site will be through transfemoral on the basis of pre-procedural evaluation of access site vessel. The procedure will be performed under local or general anesthesia and per clinical practice standard.
Department of Cardiovascular Surgery of Xijing Hospital, Air Force Military Medical University
Xi'an, Shaanxi, China
RECRUITINGWest China Hospital, Sichuan University
Chengdu, Sichuan, China
NOT_YET_RECRUITINGFuwai Hospital, Chinese Academy of Medical Sciences
Beijing, China
NOT_YET_RECRUITINGAll-cause mortality
The primary end point is the 5 year all-cause mortality
Time frame: At 5 years
The composite of all-cause mortality, stroke and rehospitalization
The composite of all-cause mortality, stroke, rehospitalization (procedure, valve and heart failure related) at 30 days, 1, 3, 5 years
Time frame: At 30 days, 1, 3, 5 years
The composite of device success
The composite of device success at 30 days comprising the following: freedom from mortality, successful access, delivery of the device, and retrieval of the delivery system, correct positioning of a single prosthetic heart valve into the proper anatomical location, freedom from surgery or intervention related to the device or to a major vascular or access-related, or cardiac structural complication, intended performance of the valve (mean gradient \<20 mmHg, peak velocity \<3 m/s, Doppler velocity index ≥0.25, and less than moderate aortic regurgitation), according to the VARC-3 definition
Time frame: At 30 days
The durability performance of Sapien 3
The durability performance of Sapien 3 at 1, 3, 5 years: bioprosthetic valve dysfunction (BVD, including SVD, non-SVD, endocarditis and thrombosis), moderate or severe hemodynamic valve deterioration (HVD), bioprosthetic valve failure (BVF) according to the VARC-3 definition, EOA/mean gradient (MG) change over follow up
Time frame: At 1, 3, 5 years
Annular rupture
The incidence of annular rupture
Time frame: At 1 day of discharge
Paravalvular leakage
The incidence of paravalvular leakage
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Shanghai Zhongshan Hospital, Fudan University
Shanghai, China
RECRUITINGTime frame: At 1 day of discharge, 30 days, 1, 3, 5 years
Technical success
Technical success (at exit from procedure room): * freedom from mortality * successful access, delivery of the device, and retrieval of the delivery system * correct positioning of a single prosthetic heart valve into the proper anatomical location * freedom from surgery or intervention related to the device or to a major vascular or access-related, or cardiac structural complication
Time frame: At exit from procedure room
Procedural success
Procedural success at 30 days defined as meeting all of the following: * Device success * No device or procedure related SAE's as follows: 1. Life-threatening bleed (BARC 3b or greater) 2. Major vascular or cardiac structural complications requiring unplanned reintervention or surgery 3. Stage 2 or 3 AKI (includes new dialysis) 4. MI or need for PCI/CABG 5. Severe heart failure or hypotension requiring IV inotrope \>12 hours, ultrafiltration or mechanical circulatory support 6. Prolonged intubation \> 48 hours 7. Need for a permanent pacemaker implant or continuous, new onset atrial fibrillation
Time frame: At 30 days
Mortality (all cause & cardiovascular)
The incidence of mortality (all cause \& cardiovascular)
Time frame: At 30 days, 1, 3, 5 years
Stroke (disabling and nondisabling)
The incidence of stroke (disabling and nondisabling)
Time frame: At 30 days, 1, 3, 5 years
Rehospitalization (procedure, valve and heart failure related)
The incidence of rehospitalization (procedure, valve and heart failure related)
Time frame: At 30 days, 1, 3, 5 years
Major vascular complication
The incidence of major vascular complication
Time frame: At 30 days, 1, 3, 5 years
Major or life-threatening bleeding
The incidence of major or life-threatening bleeding
Time frame: At 30 days, 1, 3, 5 years
Myocardial infarction
The incidence of myocardial infarction
Time frame: At 30 days, 1, 3, 5 years
Acute kidney injury stage 2 or 3
The incidence of acute kidney injury stage 2 or 3
Time frame: At 30 days, 1, 3, 5 years
Need for a permanent pacemaker
The incidence of permanent pacemaker implantation
Time frame: At 30 days, 1, 3, 5 years
New onset atrial fibrillation
The incidence of new onset atrial fibrillation
Time frame: At 30 days, 1, 3, 5 years
Valve endocarditis
The incidence of valve endocarditis
Time frame: At 30 days, 1, 3, 5 years
Valve thrombosis
The incidence of valve thrombosis
Time frame: At 30 days, 1, 3, 5 years
New York Heart Association class
The changes in New York Heart Association class
Time frame: At 30 days, 1, 3, 5 years
Patient-prosthesis mismatch
The incidence of patient-prosthesis mismatch
Time frame: At 30 days, 1, 3, 5 years
Health status as evaluated by Quality of Life questionnaires - KCCQ
The changes in Health status as evaluated by Quality of Life questionnaires - KCCQ
Time frame: At baseline, 30 days, 1, 3, 5 years