Defining Exercise Hemodynamics and Function After Transcatheter Aortic Valve Replacement (DEFINE-TAVR) Study.

Study Overview
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Brief Summary
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The purpose of this study is to help understand how the replacement valve functions over time, both at rest and during exercise.

Detailed Description
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The objective of this single-center registry is to evaluate prosthetic valve hemodynamics and function over time in patients undergoing clinically indicated transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis. Specific goals include: Describe valve hemodynamics at rest (baseline, post-procedure, 30 days, 1 year) and with exercise (at 30 days and 1 year) after TAVR implantation to define valve function and hemodynamics over time. Compare valve hemodynamics and function at rest and exercise between self-expanding and balloon expandable valves.

Official Title
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DEFINE-TAVR (Defining Exercise Hemodynamics and Function After Transcatheter Aortic Valve Replacement) Study

Conditions
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Aortic Valve Stenosis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or non-pregnant female ≥18 years of age Clinically indicated for TAVR Aortic annular size measures 21-25 mm diameter based on pre-procedure Computed Tomography Angiography (CTA) Able to exercise and, in the judgment of the investigator, is likely to be physically able to comply with the protocol requirements regarding exercise echocardiography Willing to comply with protocol-specified follow-up evaluations The participant or legally authorized representative, has been informed of the nature of the study, agrees to its provisions, and has provided written informed consent, approved by the appropriate Institutional Review Board (IRB) or Ethics Committee (EC) Exclusion Criteria: Previously implanted prosthetic aortic valve (i.e., planned valve-in-valve TAVR) Known mental or physical illness or known history of substance abuse that may cause non-compliance with the protocol, confound the data interpretation, or is associated with a life expectancy of less than one year Left ventricular ejection fraction (LVEF) <35% Presenting with cardiogenic shock at the time of the index procedure Planned to undergo any cardiac surgical procedure in the following 12 months The index procedure results in an unsuccessful TAVR, defined as procedural major adverse events (death, disabling stroke, or life-threatening or disabling bleeding), need for a second prosthesis implant, or conversion to emergent surgery

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| TransAortic Valve Gradient during exercise at 30 days post-TAVR | TransAortic Valve Gradient (mmHg) during exercise at 30 days post procedure, as assessed by the Echocardiographic Core Laboratory and summarized as peak and mean. | 30 days post-TAVR | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in valve cusp thickness at rest | Change in valve cusp thickness (mm) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in valve mobility at rest | Change in valve mobility at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in paravalvular leak at rest | Change in paravalvular leak at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in coefficient of contraction Effective Orifice Area (EOA)/Geometric Orifice Area (GOA) at rest | Change in coefficient of contraction EOA/GOA at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in Dimensionless Velocity Index (DVI) at rest | Change in DVI at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in energy loss coefficient at rest | Change in energy loss coefficient at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in EOA at rest | Change in EOA (cm2) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in aortic valve gradient (peak and mean) at rest | Change in aortic valve gradient (mmHg) (peak and mean) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in aortic valve velocity (peak and mean) at rest | Change in aortic valve velocity (m/s) (peak and mean) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in Left Ventricle (LV) remodeling at rest | Change in LV remodeling at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in leaflet thickening at rest | Change in leaflet thickening at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in coaptation length at rest | Change in coaptation length (mm) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in LV thickness at rest | Change in LV thickness (cm) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in LV Global Longitudinal Strain at rest | Change in LV Global Longitudinal Strain (%) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in Right Ventricular (RV) systolic velocity at rest | Change in RV systolic velocity (cm/s) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in RV systolic pressure (RVSP) at rest | Change in RVSP (mmHg) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in Tricuspid Annular Plane Systolic Excursion (TAPSE) at rest | Change in TAPSE (mm) at rest assessed using echocardiogram reported as absolute values and as changes. | baseline, during hospitalization approximatively 3 days, 30 days, and 12 months post-TAVR | 
| Change in aortic valve gradient (peak and mean) with exercise | Change in gradient (mmHg) (peak and mean) with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days, and 12 months post-TAVR | 
| Change in aortic valve velocity (peak and mean) with exercise | Change in aortic valve velocity (m/s) (peak and mean) with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| Change in DVI with exercise | Change in DVI with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| Change in EOA with exercise | Change in EOA (cm2) with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| Change in RVSP with exercise | Change in RVSP (mmHg) with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| Change in exercise duration | Change in exercise duration (min) reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| Change in LV Global Longitudinal Strain with exercise | Change in LV Global Longitudinal Strain (%) with exercise assessed using echocardiogram reported as absolute values and as changes. | 30 days and 12 months post-TAVR | 
| TAVR Device Success (Valve Academic Research Consortium [VARC]-defined) | TAVR Device Success evaluated post-procedure/pre-discharge during hospitalization approximatively 3 days, defined as: absence of procedural mortality AND correct positioning of a single prosthetic heart valve into the proper anatomical location AND intended performance of the prosthetic heart valve (defined as no prosthesis-patient mismatch [VARC-defined] and mean aortic valve gradient <20 mm Hg or peak velocity <3 m/s, AND no moderate or severe prosthetic valve regurgitation [VARC-defined] [site and Core Laboratory-reported]. | during hospitalization approximatively 3 days | 
| Composite Safety Endpoints (VARC-3 defined) | Composite safety endpoint reported as a proportion of participants who died or experienced neurological events or life-threatening bleeding or acute kidney injury or coronary artery obstruction requiring intervention or major vascular complications or valve-related dysfunction requiring repeat procedure evaluated at 30 days and 12 months. | 30 days and 12 months post-TAVR |