RECRUITING

ARTIST: Aortic Regurgitation Trial Investigating Surgery Versus Trilogy™

Conditions

Aortic Regurgitation Aortic Valve Insufficiency Aortic Insufficiency

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

To demonstrate non-inferiority of the Trilogy Transcatheter Heart Valve (THV) System compared with surgical aortic valve replacement (SAVR) for treatment of subjects with clinically significant native aortic regurgitation (AR)

Official Title

A Study to Assess Safety and Effectiveness of the JenaValve Trilogy™ Transcatheter Heart Valve System Versus Surgical Valve Replacement in Patients With Aortic Regurgitation

Quick Facts

Study Start:2025-06-18

Study Completion:2036-02

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT06608823

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:Not specified

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:CHILD, ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
1. Clinical indication for AVR for native valve predominant AR defined as: 1. Class I or II indication for AVR according to ACC/AHA or ESC/EACTS guidelines with moderate to severe or severe AR (Grade ≥3+) on transthoracic echocardiography, transesophageal echocardiography or cardiac MRI as assessed by the core laboratory OR 2. AR severity that remains indeterminate despite core laboratory review of all imaging including at least one advanced imaging modality (TEE or cardiac MRI) AND evidence of left ventricular damage\* from AR with unanimous agreement from the local heart team, an independent clinical evaluation committee and the CRB that the symptomatic subject (NYHA II or greater) will benefit from SAVR for AR 2. The subject is a candidate for TAVR using the Trilogy THV system and SAVR using a commercially approved bioprosthetic heart valve 3. Subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits 4. Subject meets the legal minimum age to provide informed consent based on local regulatory requirements	1. Confirmed moderate (2+) or less AR severity by core laboratory evaluation 2. Estimated life expectancy of less than 24 months due to associated non- cardiac comorbid conditions 3. Subject is high-risk for SAVR as determined by the local heart team 4. Subject refuses SAVR as a treatment option 5. Subject refuses a blood transfusion 6. Subject is selected for aortic valve repair or aortic surgery 7. Marfan syndrome or other known connective tissue disease that would necessitate aortic root replacement/intervention 8. Subject unable to undergo pre-procedure CT scan analysis for annular sizing 9. Mitral or tricuspid disease, considered clinically significant, such that if randomized to surgery, repair or replacement would be expected. 10. Subject has a known hypersensitivity or contraindication to all anticoagulation/antiplatelet medications (or inability to be anticoagulated for the index procedure), nitinol, or sensitivity to contrast media which cannot be adequately pre-medicated 11. Hostile chest or conditions or complications from a prior surgery that would preclude safe reoperation (i.e., mediastinitis, radiation damage, chest wall abnormalities, adhesion of aorta or internal mammary artery (IMA) to the sternum) 12. Need for emergency surgery or TAVR for any reason 13. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or need for mechanical circulatory support 14. Ongoing sepsis or active infective endocarditis with ongoing antibiotic (including suppressive) therapy or positive blood cultures within 6 weeks 15. Cardiac resynchronization therapy (CRT) device implantation within 30 days of randomization 16. LVEF \&amp;lt;25% according to core laboratory measurement of resting echocardiogram at time of screening 17. Moderate to severe or worse right ventricular dysfunction on resting echocardiogram according to core laboratory 18. Severe chronic liver disease (Child-Pugh C) or any active liver disease 19. Chronic Kidney Disease Stage 4 or 5 (\&amp;lt;30 cc/min/1.73 m2 or dialysis) 20. Severe Pulmonary Hypertension (pulmonary arterial systolic pressure * amp;amp;gt;2/3 systemic systolic pressure) 21. Severe Chronic Obstructive Pulmonary Disease (COPD) with FEV1 * amp;amp;lt;50% predicted or need for chronic supplementary oxygen 22. Blood dyscrasia as defined: leukopenia (WBC \&amp;lt;3,000 Cells/μL), thrombocytopenia (platelet count \&amp;lt;50,000 Cells/μL), or anemia (hemoglobin \&amp;lt;9.0 g/dL) that is uncorrected prior to randomization 23. History of bleeding diathesis or coagulopathy that is not adequately treated 24. Active gastrointestinal bleeding precluding anticoagulation or antiplatelet therapy 25. Any condition considered a contraindication to mechanical circulatory support 26. Uncontrolled atrial fibrillation (i.e., resting heart rate \&amp;gt;120 bpm) 27. Evidence of an acute myocardial infarction ≤30 days before the index AVR 28. Any percutaneous coronary or peripheral interventional procedure performed ≤30 days prior to AVR (Subjects with placement of coronary or peripheral stent(s) should be assessed for the ability to safely proceed with SAVR within the protocol timeframe) 29. Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within six weeks of randomization 30. Prior stroke with residual modified Rankin Score ≥2 31. Stroke or transient ischemic attack (TIA) within 6 months of randomization 32. Body mass index (BMI) \&amp;lt;20 or \&amp;gt;50 kg/m2 33. Currently participating in a cardiovascular investigational drug or device trial and has not yet completed follow-up for the primary endpoint (excluding registries) 34. Severe cognitive decline (resulting in either inability to provide informed consent for the trial/procedure, prevents independent lifestyle outside of a chronic care facility, or will fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits) 35. Other medical, social, or psychological conditions that in the opinion of the investigator preclude the subject from appropriate consent or adherence to the protocol required follow-up exams 36. Pregnancy or intent to become pregnant prior to completion of all protocol follow-up requirements 37. Anatomical exclusion criteria (ANY of the following): 1. Congenital bicuspid, unicuspid or quadricuspid aortic valve verified by echocardiography or CCT core laboratory 2. Native aortic annulus perimeter \&amp;lt;66 mm or \&amp;gt;90 mm per the core laboratory reading of baseline cardiac CT imaging 3. Iliofemoral arteries with vessel characteristics unsuitable for sheath passage (e.g., calcification, tortuosity) as determined by the case review board (CRB) 4. Significant abdominal or thoracic aortic disease (such as porcelain aorta, aneurysm, severe calcification, aortic coarctation) that would preclude safe passage of the delivery system or cannulation and aortotomy for SAVR 5. According to the CRB, a combination of aortic root angulation (angle between the plane of the aortic valve annulus and horizontal plane/vertebrae), sinus size, and straight length of the aorta that will not allow safe device delivery and THV deployment 6. Sinus of Valsalva anatomy that would prevent adequate coronary perfusion after valve implantation 38. According to core laboratory evaluation, severe aortic stenosis 39. Uncorrected hypertrophic obstructive cardiomyopathy 40. Echocardiographic or Multi-slice CT (MSCT) evidence of untreated intracardiac mass or vegetation 41. Left ventricular thrombus 42. Left atrial thrombus without continuous appropriate anticoagulation within 90 days of the study procedure 43. Complex coronary artery disease: 1. Unprotected left main coronary artery disease ≥50% 2. Syntax score \&amp;gt;32 (in the absence of prior revascularization) 3. Heart Team determines that optimal revascularization cannot be adequately performed with EITHER CABG at the time of SAVR OR PCI at least 30 days prior to THV implant.

Inclusion Criteria

Exclusion Criteria

1. Clinical indication for AVR for native valve predominant AR defined as:
1. Class I or II indication for AVR according to ACC/AHA or ESC/EACTS guidelines with moderate to severe or severe AR (Grade ≥3+) on transthoracic echocardiography, transesophageal echocardiography or cardiac MRI as assessed by the core laboratory OR
2. AR severity that remains indeterminate despite core laboratory review of all imaging including at least one advanced imaging modality (TEE or cardiac MRI) AND evidence of left ventricular damage\* from AR with unanimous agreement from the local heart team, an independent clinical evaluation committee and the CRB that the symptomatic subject (NYHA II or greater) will benefit from SAVR for AR
2. The subject is a candidate for TAVR using the Trilogy THV system and SAVR using a commercially approved bioprosthetic heart valve
3. Subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits
4. Subject meets the legal minimum age to provide informed consent based on local regulatory requirements

1. Confirmed moderate (2+) or less AR severity by core laboratory evaluation
2. Estimated life expectancy of less than 24 months due to associated non- cardiac comorbid conditions
3. Subject is high-risk for SAVR as determined by the local heart team
4. Subject refuses SAVR as a treatment option
5. Subject refuses a blood transfusion
6. Subject is selected for aortic valve repair or aortic surgery
7. Marfan syndrome or other known connective tissue disease that would necessitate aortic root replacement/intervention
8. Subject unable to undergo pre-procedure CT scan analysis for annular sizing
9. Mitral or tricuspid disease, considered clinically significant, such that if randomized to surgery, repair or replacement would be expected.
10. Subject has a known hypersensitivity or contraindication to all anticoagulation/antiplatelet medications (or inability to be anticoagulated for the index procedure), nitinol, or sensitivity to contrast media which cannot be adequately pre-medicated
11. Hostile chest or conditions or complications from a prior surgery that would preclude safe reoperation (i.e., mediastinitis, radiation damage, chest wall abnormalities, adhesion of aorta or internal mammary artery (IMA) to the sternum)
12. Need for emergency surgery or TAVR for any reason
13. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or need for mechanical circulatory support
14. Ongoing sepsis or active infective endocarditis with ongoing antibiotic (including suppressive) therapy or positive blood cultures within 6 weeks
15. Cardiac resynchronization therapy (CRT) device implantation within 30 days of randomization
16. LVEF \&amp;lt;25% according to core laboratory measurement of resting echocardiogram at time of screening
17. Moderate to severe or worse right ventricular dysfunction on resting echocardiogram according to core laboratory
18. Severe chronic liver disease (Child-Pugh C) or any active liver disease
19. Chronic Kidney Disease Stage 4 or 5 (\&amp;lt;30 cc/min/1.73 m2 or dialysis)
20. Severe Pulmonary Hypertension (pulmonary arterial systolic pressure
* amp;amp;gt;2/3 systemic systolic pressure)
21. Severe Chronic Obstructive Pulmonary Disease (COPD) with FEV1
* amp;amp;lt;50% predicted or need for chronic supplementary oxygen
22. Blood dyscrasia as defined: leukopenia (WBC \&amp;lt;3,000 Cells/μL), thrombocytopenia (platelet count \&amp;lt;50,000 Cells/μL), or anemia (hemoglobin \&amp;lt;9.0 g/dL) that is uncorrected prior to randomization
23. History of bleeding diathesis or coagulopathy that is not adequately treated
24. Active gastrointestinal bleeding precluding anticoagulation or antiplatelet therapy
25. Any condition considered a contraindication to mechanical circulatory support
26. Uncontrolled atrial fibrillation (i.e., resting heart rate \&amp;gt;120 bpm)
27. Evidence of an acute myocardial infarction ≤30 days before the index AVR
28. Any percutaneous coronary or peripheral interventional procedure performed ≤30 days prior to AVR (Subjects with placement of coronary or peripheral stent(s) should be assessed for the ability to safely proceed with SAVR within the protocol timeframe)
29. Symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within six weeks of randomization
30. Prior stroke with residual modified Rankin Score ≥2
31. Stroke or transient ischemic attack (TIA) within 6 months of randomization
32. Body mass index (BMI) \&amp;lt;20 or \&amp;gt;50 kg/m2
33. Currently participating in a cardiovascular investigational drug or device trial and has not yet completed follow-up for the primary endpoint (excluding registries)
34. Severe cognitive decline (resulting in either inability to provide informed consent for the trial/procedure, prevents independent lifestyle outside of a chronic care facility, or will fundamentally complicate rehabilitation from the procedure or compliance with follow-up visits)
35. Other medical, social, or psychological conditions that in the opinion of the investigator preclude the subject from appropriate consent or adherence to the protocol required follow-up exams
36. Pregnancy or intent to become pregnant prior to completion of all protocol follow-up requirements
37. Anatomical exclusion criteria (ANY of the following):
1. Congenital bicuspid, unicuspid or quadricuspid aortic valve verified by echocardiography or CCT core laboratory
2. Native aortic annulus perimeter \&amp;lt;66 mm or \&amp;gt;90 mm per the core laboratory reading of baseline cardiac CT imaging
3. Iliofemoral arteries with vessel characteristics unsuitable for sheath passage (e.g., calcification, tortuosity) as determined by the case review board (CRB)
4. Significant abdominal or thoracic aortic disease (such as porcelain aorta, aneurysm, severe calcification, aortic coarctation) that would preclude safe passage of the delivery system or cannulation and aortotomy for SAVR
5. According to the CRB, a combination of aortic root angulation (angle between the plane of the aortic valve annulus and horizontal plane/vertebrae), sinus size, and straight length of the aorta that will not allow safe device delivery and THV deployment
6. Sinus of Valsalva anatomy that would prevent adequate coronary perfusion after valve implantation
38. According to core laboratory evaluation, severe aortic stenosis
39. Uncorrected hypertrophic obstructive cardiomyopathy
40. Echocardiographic or Multi-slice CT (MSCT) evidence of untreated intracardiac mass or vegetation
41. Left ventricular thrombus
42. Left atrial thrombus without continuous appropriate anticoagulation within 90 days of the study procedure
43. Complex coronary artery disease:
1. Unprotected left main coronary artery disease ≥50%
2. Syntax score \&amp;gt;32 (in the absence of prior revascularization)
3. Heart Team determines that optimal revascularization cannot be adequately performed with EITHER CABG at the time of SAVR OR PCI at least 30 days prior to THV implant.

Contacts and Locations

Study Contact

Duane Pinto, MD MPH

CONTACT

949-767-2110

pinto@jenavalve.com

Principal Investigator

Vinod H Thourani, MD

PRINCIPAL_INVESTIGATOR

Piedmont Heart Institute

Torsten P Vahl, MD

PRINCIPAL_INVESTIGATOR

Columbia University

Raj Makkar, MD

PRINCIPAL_INVESTIGATOR

Cedars-Sinai Medical Center

Hendrik Treede, MD

PRINCIPAL_INVESTIGATOR

Department of Cardiovascular Surgery Johannes-Gutenberg University

Study Locations (Sites)

Cedar-Sinai Medical Center

Los Angeles, California, 90048

United States

BayCare Health

Clearwater, Florida, 33756

United States

Emory University Hospital

Atlanta, Georgia, 30308

United States

Cumc/Nyph

New York, New York, 10032

United States

Houston Methodist Research Institute

Houston, Texas, 77030

United States

Collaborators and Investigators

Sponsor: JenaValve Technology, Inc.

Vinod H Thourani, MD, PRINCIPAL_INVESTIGATOR, Piedmont Heart Institute
Torsten P Vahl, MD, PRINCIPAL_INVESTIGATOR, Columbia University
Raj Makkar, MD, PRINCIPAL_INVESTIGATOR, Cedars-Sinai Medical Center
Hendrik Treede, MD, PRINCIPAL_INVESTIGATOR, Department of Cardiovascular Surgery Johannes-Gutenberg University

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-06-18

Study Completion Date2036-02

Study Record Updates

Study Start Date2025-06-18

Study Completion Date2036-02

Terms related to this study

Additional Relevant MeSH Terms

Aortic Regurgitation
Aortic Valve Insufficiency
Aortic Insufficiency