Tricuspid Valve Replacement for Tricuspid Regurgitation

(TRICURE EFS Trial)

Recruiting at 7 trial locations

Overseen By Esther Gerteis

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: TRiCares

Disqualifiers: Emergent intervention, Hemodynamic instability, Anatomical contraindications, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 31

Duration: 1 day

10 Participants Needed

Trial Summary

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the idea that Tricuspid Valve Replacement for Tricuspid Regurgitation is an effective treatment?

The available research shows that Tricuspid Valve Replacement (TTVR) is a promising treatment for severe tricuspid regurgitation, especially in high-risk patients. It is considered safer than traditional surgery, which has high risks. TTVR is expected to improve survival rates and effectively address the heart valve issues caused by tricuspid regurgitation. While still in early development, TTVR is seen as a significant advancement compared to other treatments. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Transcatheter Tricuspid Valve Replacement for Tricuspid Regurgitation?

Research shows that Transcatheter Tricuspid Valve Replacement (TTVR) is a promising treatment for severe tricuspid regurgitation, especially in high-risk patients who cannot undergo surgery. Early studies suggest that TTVR can significantly improve survival and address the heart valve issues effectively. ^{1 2 3 4 5}

What safety data exists for Tricuspid Valve Replacement for Tricuspid Regurgitation?

The provided research does not contain any safety data specific to Tricuspid Valve Replacement for Tricuspid Regurgitation or its related terms such as Transcatheter Tricuspid Valve Replacement or TTVR. The studies focus on mitral valve procedures and COVID-19 vaccine safety, which are unrelated to the tricuspid valve treatment in question. ^{6 7 8 9 10}

Is Transcatheter Tricuspid Valve Replacement a promising treatment for tricuspid regurgitation?

Yes, Transcatheter Tricuspid Valve Replacement (TTVR) is a promising treatment for tricuspid regurgitation. It is emerging as a new option for patients, especially those who are at high risk for traditional surgery. TTVR is seen as a safer and effective alternative to open-heart surgery, and it may help improve heart and liver function in patients with this condition. ^{1 2 3 11 12}

How is the treatment Transcatheter Tricuspid Valve Replacement (TTVR) different from other treatments for tricuspid regurgitation?

Transcatheter Tricuspid Valve Replacement (TTVR) is unique because it offers a less invasive alternative to open-heart surgery for treating tricuspid regurgitation, which is a condition with limited effective medical treatments and high surgical risks. Unlike traditional surgical methods, TTVR is performed through a catheter, reducing recovery time and potentially lowering the risk of complications. ^{1 2 3 11 12}

What is the purpose of this trial?

Prospective, multi-center study to assess safety and performance of the TRiCares Topaz Tricuspid Valve Replacement System

Research Team

Susheel Kodali, MD

Principal Investigator

Columbia University Medical Center/ NewYork Presbyterian Hospital

Gorav Ailawadi

Principal Investigator

University of Michigan Hospital and Health Systems

Eligibility Criteria

This trial is for adults with severe tricuspid valve regurgitation, who are considered at high risk for surgery by a heart team. It's not suitable for those with anatomy that doesn't fit the device, involved in another study without reaching its main goal yet, needing urgent intervention or unstable.

Inclusion Criteria

I have severe tricuspid regurgitation.

I am 18 years old or older.

Institutional Heart Team evaluates patient as being at increased operative risk

Exclusion Criteria

My body cannot safely accommodate the study device due to its structure.

Patient who is currently participating in another clinical investigation where the primary endpoint was not reached yet

Patient in need of emergent intervention

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the TRiCares Topaz Tricuspid Transcatheter Valve Replacement System

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years

Multiple visits at 30 days, 6 months, and annually

Treatment Details

Interventions

• Transcatheter Tricuspid Valve Replacement

Trial Overview The study tests the TRiCares Topaz Tricuspid Valve Replacement System's safety and performance. It's a forward-looking study conducted across multiple centers where participants receive this new transcatheter heart valve replacement.

Participant Groups

Group I: Transcatheter Tricuspid Valve Replacement Experimental Treatment 1 Intervention

Treatment with the TRiCares Topaz Tricuspid Transcatheter Valve Replacement System

Transcatheter Tricuspid Valve Replacement is already approved in United States, European Union for the following indications:

Approved in United States as Transcatheter Tricuspid Valve Replacement for:

• Severe tricuspid regurgitation
• Symptomatic tricuspid valve disease

Approved in European Union as Transcatheter Tricuspid Valve Replacement for:

• Severe tricuspid regurgitation
• Symptomatic tricuspid valve disease

Who Is Running the Clinical Trial?

TRiCares

Lead Sponsor

Trials

3

Recruited

110+

Findings from Research

Transcatheter tricuspid valve replacement (TTVR) was performed successfully in 46 high-risk patients with severe tricuspid regurgitation, achieving a procedural success rate of 97.8% and significantly reducing the severity of TR after 6 months.

The procedure demonstrated a favorable safety profile, with a 6-month mortality rate of 17.4% and a significant reduction in symptoms like peripheral edema and ascites, indicating improved patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Lu, FL., An, Z., Ma, Y., et al.[2021]

In a study of 28 patients with severe tricuspid regurgitation, the edge-to-edge transcatheter tricuspid valve repair (TTVr) successfully reduced tricuspid regurgitation by at least one grade in all patients, demonstrating high efficacy.

At three months post-procedure, 83% of patients improved to NYHA class I or II, and only one patient experienced a minor complication, indicating that TTVr is a safe and effective treatment option for severe tricuspid regurgitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program. Cepas-Guillen, PL., de la Fuente Mancera, JC., Guzman Bofarull, J., et al.[2021]

The meta-analysis of 35 studies involving 5,316 patients found that the operative mortality rate for isolated surgical tricuspid valve replacement (TVR) was 12%, with higher risks for patients operated on before 1995, those with prior cardiac surgeries, or liver disease.

Common complications following surgical TVR included pacemaker implantation (10%), bleeding (12%), acute kidney injury (15%), and respiratory issues (15%), highlighting the need for careful patient selection and management in future transcatheter tricuspid valve replacement trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies. Scotti, A., Sturla, M., Granada, JF., et al.[2023]

Transcatheter tricuspid valve replacement (TTVR) is a promising treatment for patients with severe tricuspid regurgitation, particularly those with significant annular dilation and large coaptation gaps, which are difficult to address with traditional surgery.

Most TTVR devices are still in early clinical development, but one device is currently in a pivotal trial, suggesting that TTVR could greatly improve outcomes and survival rates for these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Orthotopic Transcatheter Tricuspid Valve Replacement. Greenbaum, AB., Babaliaros, VC., Eng, MH.[2021]

In a study of 17,483 patients undergoing aortic valve replacement (AVR), those with more severe tricuspid regurgitation (TR) experienced higher rates of morbidity and mortality, highlighting the risks associated with TR during AVR.

While tricuspid intervention during AVR did not significantly increase operative mortality, it was linked to a higher rate of major complications (51% vs 26%), suggesting that careful consideration is needed when deciding on tricuspid correction in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of tricuspid regurgitation with and without repair during aortic valve replacement. Chancellor, WZ., Mehaffey, JH., Beller, JP., et al.[2021]

The expert panel confirmed a low incidence of mitral valve leaflet adverse events (LAE) at 2.0% in the EXPAND study, indicating that the MitraClip NTR/XTR device is safe for mitral valve repair.

Among the confirmed cases, most were single leaflet device attachments (SLDA), which were often resolved with additional clips, suggesting effective management of these events compared to older-generation devices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incidence and standardised definitions of mitral valve leaflet adverse events after transcatheter mitral valve repair: the EXPAND study. Asch, FM., Little, SH., Mackensen, GB., et al.[2023]

A retrospective analysis of Vaccine Adverse Event Reporting System (VAERS) data revealed that embolic and thrombotic events (ETEs) were reported following COVID-19 vaccination, with a median onset time of 6 days for mRNA vaccines and 11 days for viral vector vaccines.

The study indicates that the type of COVID-19 vaccine influences the likelihood and timing of ETEs, suggesting that healthcare providers should monitor patients for these events based on the specific vaccine administered.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trends in reporting embolic and thrombotic events after COVID-19 vaccination: A retrospective, pharmacovigilance study. Kan, Y., Asada, M., Uesawa, Y.[2022]

The European Medicines Agency (EMA) effectively monitored COVID-19 vaccine safety by implementing enhanced surveillance and independent studies, which led to the rapid identification of safety signals like thrombosis with thrombocytopenia syndrome (TTS) and myocarditis/pericarditis.

The combination of spontaneous reporting and real-world data allowed for quick risk assessment and communication, highlighting the need for improved data collection methods across EU Member States to better evaluate vaccine safety in diverse populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Monitoring of COVID-19 Vaccines: Perspective from the European Medicines Agency. Durand, J., Dogné, JM., Cohet, C., et al.[2023]

A total of 604,157 adverse events (AEs) were reported for COVID-19 vaccines, with the Pfizer-BioNTech and Moderna vaccines accounting for the majority of reports, indicating a need for ongoing safety monitoring.

While most reported AEs were mild, serious outcomes like hospitalization and life-threatening events were noted, particularly among older adults with pre-existing conditions, highlighting the importance of careful surveillance of vaccine safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Characteristics and Comparison of Adverse Events of Coronavirus Disease 2019 Vaccines Reported to the United States Vaccine Adverse Event Reporting System Between 14 December 2020 and 8 October 2021. Zou, C., Xue, X., Qian, J.[2022]

Vaccine-induced prothrombotic immune thrombocytopenia is a very rare adverse event associated with viral vector COVID-19 vaccines, primarily affecting women under 60, leading to temporary pauses in vaccination campaigns for Vaxzevria and Janssen vaccines.

Despite these rare events, mRNA vaccines have been shown to be safe in post-marketing surveillance, with no increased reports of thrombotic events in individuals over 60, who are at higher risk for severe COVID-19 outcomes, indicating that vaccination should continue in this age group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Thrombotic events and COVID-19 vaccines. Brazete, C., Aguiar, A., Furtado, I., et al.[2023]

In a study of 80 patients with symptomatic tricuspid regurgitation treated with either the PASCAL or MitraClip-XTR device, both systems showed similar effectiveness in reducing TR severity, with 91% of PASCAL patients and 96% of MitraClip-XTR patients achieving at least a one-grade reduction at 30 days.

Both devices were found to be safe, with no periprocedural deaths and comparable 30-day and 3-month mortality rates, indicating that TTVR is a viable option for high-surgical-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of tricuspid regurgitation: a propensity-matched analysis. Sugiura, A., Vogelhuber, J., Öztürk, C., et al.[2021]

In a study of 22 patients with severe tricuspid regurgitation (TR), transcatheter tricuspid valve replacement (TTVR) led to significant reductions in liver and heart volumes after 6 months, indicating positive remodeling effects.

The left hepatic lobe volume decreased significantly, and there was a notable reduction in right atrial volume, suggesting that TTVR can effectively reverse the adverse effects of TR on hepatic and cardiac structures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of transcatheter tricuspid valve replacement for tricuspid regurgitation on hepatic, cardiac, and venous structure. Ning, X., Cao, J., Wang, W., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. [2021]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program. [2021]

3. France pubmed.ncbi.nlm.nih.gov

Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies. [2023]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Orthotopic Transcatheter Tricuspid Valve Replacement. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of tricuspid regurgitation with and without repair during aortic valve replacement. [2021]

6. France pubmed.ncbi.nlm.nih.gov

Incidence and standardised definitions of mitral valve leaflet adverse events after transcatheter mitral valve repair: the EXPAND study. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Trends in reporting embolic and thrombotic events after COVID-19 vaccination: A retrospective, pharmacovigilance study. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Safety Monitoring of COVID-19 Vaccines: Perspective from the European Medicines Agency. [2023]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Characteristics and Comparison of Adverse Events of Coronavirus Disease 2019 Vaccines Reported to the United States Vaccine Adverse Event Reporting System Between 14 December 2020 and 8 October 2021. [2022]

10. France pubmed.ncbi.nlm.nih.gov

Thrombotic events and COVID-19 vaccines. [2023]

11. Germany pubmed.ncbi.nlm.nih.gov

PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of tricuspid regurgitation: a propensity-matched analysis. [2021]

12. Netherlands pubmed.ncbi.nlm.nih.gov

Impact of transcatheter tricuspid valve replacement for tricuspid regurgitation on hepatic, cardiac, and venous structure. [2023]