partner 3 trial: safety and effectiveness of the sapien 3 transcatheter heart valve in low risk patients with aortic stenosis

Conditions: Aortic Stenosis

Summary: to establish the safety and effectiveness of the edwards sapien 3 transcatheter heart valve (thv) in patients with severe, calcific aortic stenosis who are at low operative risk for standard aortic valve replacement.

prospective, randomized, controlled, multi-center trial. patients having an operative mortality \< 4% (low operative risk) for surgical aortic valve replacement will be randomized 1:1 to receive either transcatheter heart valve replacement (tavr) with the edwards sapien 3 or aortic valve replacement with a commercially available surgical bioprosthetic valve. patients will be seen for follow-up visits at discharge, 30 days, 6 months, and annually through 10 years. a subset of partner 3 randomized patients will be enrolled in the actigraphy/quality of life. additional patients will be enrolled in either the bicuspid registry, underrepresented populations registry (upr) or the alternative access registry.

Eligibility criteria:
inclusion criteria: 1. severe, calcific aortic stenosis 2. new york heart association functional class ≥ 2 or exercise tolerance test that demonstrates a limited exercise capacity, abnormal bp response, or arrhythmia or asymptomatic with left ventricular ejection fraction (lvef) \<50% 3. heart team agrees the patient has a risk of operative mortality and has an society of thoracic surgeons (sts) score \< 4 4. the study patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent. exclusion criteria: 1. native aortic annulus size unsuitable for sizes 20, 23, 26, or 29 mm transcatheter heart valve 2. iliofemoral vessel characteristics that would preclude safe passage of the introducer sheath 3. evidence of an acute myocardial infarction ≤ 30 days before randomization 4. aortic valve is unicuspid, bicuspid, or non-calcified 5. severe aortic regurgitation (\>3+) 6. severe mitral regurgitation (\>3+) ≥ moderate stenosis 7. pre-existing mechanical or bioprosthetic valve in any position 8. complex coronary artery disease: 1. unprotected left main coronary artery 2. syntax score \> 32 3. heart team assessment that optimal revascularization cannot be performed 9. symptomatic carotid or vertebral artery disease or successful treatment of carotid stenosis within 30 days of randomization 10. leukopenia, anemia, thrombocytopenia, history of bleeding diathesis or coagulopathy, or hypercoagulable states 11. hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation or mechanical heart assistance within 30 days of randomization 12. hypertrophic cardiomyopathy with obstruction 13. ventricular dysfunction with lvef \< 30% 14. cardiac imaging evidence of intracardiac mass, thrombus or vegetation 15. inability to tolerate or condition precluding treatment with antithrombotic/anticoagulation therapy during or after the valve implant procedure 16. stroke or transient ischemic attack within 90 days of randomization 17. renal insufficiency and/or renal replacement therapy at the time of screening. 18. active bacterial endocarditis within 180 days of randomization 19. severe lung disease or currently on home oxygen 20. severe pulmonary hypertension 21. history of cirrhosis or any active liver disease 22. significant frailty as determined by the heart team 23. significant abdominal or thoracic aortic disease that would preclude safe passage of the delivery system or cannulation and aortotomy for surgical aortic valve replacement 24. hostile chest or conditions or complications from prior surgery that would preclude safe reoperation 25. patient refuses blood products 26. body mass index \> 50 kg/m2 27. estimated life expectancy \< 24 months 28. absolute contraindications or allergy to iodinated contrast that cannot be adequately treated with pre-medication 29. immobility that would prevent completion of study procedures 30. patient is not a candidate for both arms of the study 31. currently participating in an investigational drug or another device study.

Keywords: sapien 3 cardiovascular disease heart disease aortic stenosis surgical aortic valve replacement (savr) transcatheter aortic valve replacement (tavr)