NHLBI DIR LAMPOON Study: Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Implantation
Transcatheter mitral valve replacement (TMVR) is recommended for some people with heart problems. But the usual TMVR techniques might cause an obstruction for some people. A new technique is called LAMPOON. It may have less risk of obstruction. Participants in this study will be among the first in the world to have this technique done.
To test the safety and effectiveness of the LAMPOON technique in TMVR.
Adults ages 21 and over who are recommended to have TMVR with LAMPOON
Participants will be screened with medical history and exam and by review of medical records.
Participants will have blood tests, a scan, and a heart test before the procedure.
Participants will have TMVR with LAMPOON. They will have anesthesia. Doctors will use a wire to split the diseased mitral valve and move it out of the way. They will replace a heart valve.
Participants will stay in the hospital for about 1 month.
They will repeat the previous tests before leaving the hospital, 1 month later, and 1 year later.
They will have yearly follow-up phone calls for about 5 years.
In the event of a participant s death, researchers will ask for an autopsy and to analyze the heart. Permission for this is not required as part of the study.
Mitral Valve Failure
Device: Edwards SAPIEN 3 transcatheter heart valve
Device: ASHI INTECC Astato XS 20
|Study Design:||Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
|Official Title:||NHLBI DIR LAMPOON Study: Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Implantation|
- Technical success, acceptable [ Time Frame: 30 d ]
- Technical success, optimal [ Time Frame: 30 d ]
- MVARC 30-day device success [ Time Frame: 30 days ]
- LVOT obstruction [ Time Frame: 0d, predischarge, 30d, 12 mo ]
- MVARC 30-day procedure success [ Time Frame: 30 days ]
- MVARC 1-year patient success [ Time Frame: 1 year ]
- Mortality, all cause [ Time Frame: Predischarge, 30d, annually x 5 yr ]
- Stroke [ Time Frame: Predischarge, 30d ]
- Miocardial infarction [ Time Frame: Predischarge ]
- Access complications [ Time Frame: Predischarge ]
- MVARC bleeding [ Time Frame: Predischarge, 30d ]
- AKIN kidney injury [ Time Frame: Predischarge, 30d ]
- Arrhythmia and conduction disturbances [ Time Frame: Predischarge ]
- Infection [ Time Frame: Predischarge, 30d, 1y ]
- Hemolytic anemia [ Time Frame: Predischarge, 30d, 1y ]
- Device technical failure [ Time Frame: Predischarge, 30d ]
- Aortic valve regurgitation changes [ Time Frame: Predischarge, 30d, 1y ]
- Device thrombosis [ Time Frame: Predischarge, 30d, annually x 5 yr ]
- Neo LVOT area [ Time Frame: 30d ]
- Outcomes in elderly [ Time Frame: Predischarge, 30d, annually x 5 yr ]
|Study Start Date:||January 3, 2017|
|Estimated Study Completion Date:||December 31, 2018|
|Estimated Primary Completion Date:||December 31, 2018 (Final data collection date for primary outcome measure)|
Experimental: Arm 1
The LAMPOON procedure has three steps: (1) leaflet traversal with a guidewire, followed by (2) leaflet laceration, immediately followed by (3) TMVR. These are all guided by fluoroscopy combined with TEE or intracardiac echocardiography.
Device: Edwards SAPIEN 3 transcatheter heart valve
Used to relieve aortic stenosis in patients with symptomatic heart diseaseDevice: ASHI INTECC Astato XS 20
The Astato 0.014" guidewire is used for transcatheter electrosurgery in two steps in this procedure. First it is used for leaflet traversal during electrification. This procedure is similar to the use of the Astato XS20 and an amputated Asahi Confienza Pro 12 in the transcaval IDE investigation recently published. Second, the midshaft is focally denuded and electrified for the leaflet traversal step.
Transcatheter mitral valve replacement (TMVR) is an option to treat mitral valve failure when no surgical options exist. In as many as half of patients, TMVR can cause life-threatening blockage of the left ventricle by displacing the existing mitral valve leaflet. For these patients the only options appear to avoid TMVR or in some to cause a focused heart attack and to wait 6 weeks. The investigators have developed and tested a technique to tear the existing mitral valve leaflet and enable TMVR in patients who have no other options. The procedure is called intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON). Although there are no dedicated TMVR devices commercially available, there has been short-term success with implanted transcatheter aortic valve devices in the mitral position for TMVR.
The purpose of this study is to perform LAMPOON and TMVR in patients who have no good options to treat their mitral valve failure, using heart valve devices designed to implant in the aortic valve position.
Please refer to this study by its ClinicalTrials.gov identifier: NCT03015194
|Contact: Robert J Lederman, M.D.||(301) firstname.lastname@example.org|
|United States, Georgia|
|Emory University||Not yet recruiting|
|Atlanta, Georgia, United States, 30322-1102|
|Contact: Vasilis Babaliaros 678-557-4514 email@example.com|
|United States, Michigan|
|Henry Ford Hospital||Not yet recruiting|
|Detroit, Michigan, United States, 48202|
|Contact: Adam Greenbaum, M.D. 313-926-3826 firstname.lastname@example.org|
|Principal Investigator:||Robert J Lederman, M.D.||National Heart, Lung, and Blood Institute (NHLBI)|