Active, not recruiting
Not applicable
TRIcvalve biCAVal Valve System for Severe Tricuspid Regurgitation (TRICAV-I)
Condition(s) studied
Tricuspid RegurgitationTricuspid Valve Disease
Investigational drug(s) / intervention(s)
TricValve® Transcatheter Bicaval Valve System
TricValve® Transcatheter Bicaval Valve System: The TricValve® Transcatheter Bicaval Valve System is a bicaval transcatheter tricuspid valve replacement system, which includes the TricValve® Transcatheter Bicaval Valve for superior vena cava (SVC) and the TricValve® Transcatheter Bicaval Valve for inferior vena cava (IVC). The system is a single use, sterile device compatible with all the valve sizes. The valves are premounted in the TricValve® Delivery System. The prostheses are implanted percutaneously into the inferior and superior vena cava without disturbing the native tricuspid valve. The device is made of bovine pericardium leaflets sutured on a nitinol self-expanding stent system available in sizes 25 and 29 for superior vena cava and 31 and 35 for inferior vena cava. The valve is implanted percutaneously by the transfemoral approach. The valves are supplied already premounted into the TricValve® Delivery System.
Study summary
The TricValve® Transcatheter Bicaval Valve System is a bicaval transcatheter tricuspid valve replacement system, which includes the TricValve® Transcatheter Bicaval Valve for superior vena cava (SVC) and the TricValve® Transcatheter Bicaval Valve for inferior vena cava (IVC). The TricValve® Transcatheter Bicaval Valves are pre-mounted into the TricValve® Delivery System which is used for percutaneous access and delivery of the TricValve® Transcatheter Bicaval Valve in the vena cava. The system is a single use, sterile device compatible with all the valve sizes. The prostheses are implanted percutaneously into the inferior and superior vena cava without disturbing the native tricuspid valve. The device is made of bovine pericardium leaflets sutured on a nitinol self-expanding stent system.
Eligibility
Inclusion Criteria:
1. Subject must be 18 years or older, at the time of signing the informed consent.
2. Subjects has severe tricuspid regurgitation (TR), as determined by the qualifying transthoracic echocardiogram (TTE) confirmed by an echocardiography Core Lab.
3. NYHA Class III-IVa (not on inotropes, IABP or LVAD) or heart failure (HF) admission in the past 6 months.
4. Subject is adequately treated with optimal medical therapy (OMT) for heart failure per the local Heart Team for at least 30 days prior to the index procedure, including a diuretic.
5. The local Heart Team and IEC determine that the patient is eligible for the TricValve procedure.
6. For females of childbearing potential, negative pregnancy test.
7. Capable of giving signed informed consent.
Exclusion Criteria:
1. Subject had a recent MI, stroke or cardiovascular accident; underwent coronary artery bypass graft surgery, had a percutaneous coronary intervention or other major cardiovascular surgery within 90 days prior to TricValve implantation.
2. Subject requires another planned major cardiac procedure, including left-sided transcatheter intervention or surgery (e.g. severe aortic stenosis, severe mitral regurgitation), coronary artery bypass or PCI or pulmonary valve correction. Please note that if closure of an ASD, iatrogenic ASD or PFO is performed, TricValve implantation can be performed 30 days after the intervention. Additionally, TricValve implantation can be performed 30 days after any Electrophysiology procedure (pacemaker, ICD, etc.).
3. LVEF ≤ 30% on echocardiography.
4. Evidence of intracardiac, inferior vena cava (IVC), or femoral venous mass, thrombus or vegetation.
5. Tricuspid stenosis. (Per TVARC, echo criteria: TVA at least 1.5 cm2 or TVAi at least 0.9 cm2/m2 \[at least 0.75 if BMI \>30 kg/m2\], DVI \<2.2, mean gradient \<5mm Hg); reduction of total tricuspid regurgitation to optimal (≤ mild \[1+\]) or acceptable (≤ moderate \[2+\]).
6. Severe right ventricular dysfunction.
7. Cardiac amyloidosis
8. Pulmonary artery systolic pressure (PASP) \>65 mmHg assessed with Echo Doppler and /or right heart catheterization.
9. Lower extremity venous thrombosis and/or the presence of an IVC filter at the time of or 6 months prior to TricValve procedure.
10. Hemodynamically significant pericardial effusion.
11. Patient with refractory heart failure requiring advanced intervention (i.e. left ventricular assist device, transplantation) (ACC/ AHA/ ESC/ EACTS Stage D heart failure)
12. Any known allergy or hypersensitivity to nitinol, bovine tissue or contrast media that cannot be adequately treated with pre-medication.
13. Unable to tolerate anticoagulation/antiplatelet therapy
14. Hemodynamic instability, cardiogenic shock, inotropic support, intra-aortic balloon pump or acute heart failure within 30 days prior to the TricValve procedure.
15. Any known life-threatening condition with an estimated life span of at least 12 months.
16. Platelet count \< 75,000/mm3
17. Child-Pugh Severity Class C (10-15 points).
18. Severe renal insufficiency with estimated glomerular filtration rate (eGFR) ≤ 25 mL/min/1.73 m2 or requiring chronic renal replacement therapy at the time of enrollment.
19. Endocarditis or active/ongoing infection requiring antibiotics.
20. Unable to walk at least 60 meters in a 6minute walk test.
21. Known bleeding or clotting disorders or patient refuses blood transfusion.
22. Active gastrointestinal (GI) bleeding within 3 months of randomization.
23. Presence of significant congenital heart disease including but not limited to hemodynamically significant atrial septal defect, RV dysplasia, and arrhythmogenic RV.
24. Use or participation in other investigational device or drug study in which patient has not reached a primary endpoint to treat cardiovascular conditions related to the outcomes of the current study.
25. Any other condition that would preclude ability to meet study requirements in the opinion of the investigator.
26. Psychiatric/behavioral issues or other medical or social conditions that preclude valid consent and follow-up
27. Pregnant or breastfeeding subjects and those who plan pregnancy during the clinical investigation follow-up period.
Primary outcome measure(s)
- Mortality — 1 Month and 12 Months
Number of days until death
- Stroke — 1 Month
Number of days until death
- Pulmonary Embolism — 1 Month
Number of days until death
- Valve Academic Research Consortium (VARC) type 2-4 bleeding complication — 1 Month
Number of days until death
- Major vascular, access-related, or cardiac structural complication — 1 Month
Number of days until death
- Stage 3 Acute Kidney Injury with increase in serum creatinine >300% (>3.0x increase) and/or serum creatinine ≥4.0mg/dL (≥354 μmol/L) with an acute increase of ≥ 0.5 mg/dL (≥44 μmol/L) — 7 Days
Number of days from baseline until increase
- Stage 4 Acute Kidney Injury requiring new temporary or permanent renal replacement therapy — 1 Month
Number of days until new renal replacement therapy
- Emergency surgery or intervention related to the device/procedure complications — 1 Month
Number of days until emergency surgery or intervention
- Right Ventricular Assist Device (RVAD) implantation or heart transplant — 12 Months
Number of days until Right Ventricular Assist Device (RVAD) implantation or heart transplant
- Tricuspid valve surgery or percutaneous tricuspid intervention — 12 Months
Number of days until tricuspid valve surgery or percutaneous tricuspid intervention
- Heart Failure Events — 12 Months
Number of heart failure episodes including hospitalization, or worsening heart failure
- Kansas City Cardiomyopathy Questionnaire (KCCQ) Score — 12 Months
Change in KCC score (score ranges between 0 and 100)
- New York Heart Association (NYHA class) — 12 Months
Change in NYHA class (range from I to IV)
- Six Minute Walking Test (6MWT) — 12 Months
Change in walking distance
Trial sites (36)
| Facility | City | Region | Status |
| St. Joseph's Hospital and Medical Center |
Phoenix |
Arizona |
|
| Tucson Medical Center |
Tucson |
Arizona |
|
| Scripps Memorial Hospital La Jolla |
San Diego |
California |
|
| UCSF |
San Francisco |
California |
|
| Delray Medical Center |
Delray Beach |
Florida |
|
| Largo Medical Center |
Largo |
Florida |
|
| Tampa General Hospital |
Tampa |
Florida |
|
| Endeavor Health, Glenbrook Hospital |
Glenview |
Illinois |
|
| Chicago Advocate Christ |
Palos Park |
Illinois |
|
| Ascension Medical Group St. Vincent The Heart Center of Indiana |
Indianapolis |
Indiana |
|
| Cardiovascular Institute of the South |
Houma |
Louisiana |
|
| Massachusetts General Hospital |
Boston |
Massachusetts |
|
| Beth Israel Deaconess Medical Center |
Boston |
Massachusetts |
|
| Lahey Hospital & Medical Center |
Burlington |
Massachusetts |
|
| Minneapolis Heart Institute Foundation |
Minneapolis |
Minnesota |
|
| Saint Luke's Mid America Heart Institute |
Kansas City |
Missouri |
|
| Washington University St Louis |
St Louis |
Missouri |
|
| Hackensack University Medical Center |
Hackensack |
New Jersey |
|
| North Shore University Hospital |
Manhasset |
New York |
|
| Montefiore Medical Center |
The Bronx |
New York |
|
| Duke Cardiology Clinic |
Durham |
North Carolina |
|
| Cleveland Clinic |
Cleveland |
Ohio |
|
| Riverside Methodist Hospital |
Columbus |
Ohio |
|
| Oregon Health Services |
Portland |
Oregon |
|
| UPMC Pinnacle |
Harrisburg |
Pennsylvania |
|
| UPMC Presbyterian Shadyside |
Pittsburgh |
Pennsylvania |
|
| WellSpan York Hospital |
York |
Pennsylvania |
|
| MUSC |
Charleston |
South Carolina |
|
| Houston Methodist |
Houston |
Texas |
|
| University of Texas (Memorial Hermann) |
Houston |
Texas |
|
| Intermountain Heart Institute - Intermountain Medical Center |
Murray |
Utah |
|
| UVA School of Medicine |
Charlottesville |
Virginia |
|
| Sentara Healthcare |
Norfolk |
Virginia |
|
| Carilion Clinic |
Roanoke |
Virginia |
|
| MedStar Washington Hospital Center |
Multiple Locations |
Washington |
|
| Swedish Medical Center |
Seattle |
Washington |
|
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