BioGlue as an Adjunct for Structural Repair and Hemostasis in Chinese Acute Type A Aortic Dissections Patients

Study Overview
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Brief Summary
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A multi-center, randomized, controlled clinical trial is designed to investigate the safety and efficacy of BioGlue as an adjunct for structural repair and hemostasis to traditional surgical repair in Chinese subject with Acute type A aortic dissections.

Detailed Description
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A multi-center, randomized, controlled clinical trial is designed to investigate the safety and efficacy of BioGlue as an adjunct for structural repair and hemostasis in Chinese subjects with acute type A aortic dissection. The trial consists of three phases: Phase One - A non-randomized, lead-in phase. During the lead-in phase, the first 2-3 eligible subjects at each center will receive BioGlue in open surgery. These subjects will be evaluated for safety separately from the randomized phase of the trial. Phase Two - A randomized, controlled phase. Type A aortic dissection subjects will be randomized into TSR group (control group) and surgical repair with BioGlue group (test group) with a ratio of 1:1, so that equal number of subjects in test and control groups can be ensured. Phase Three - A Follow-up of Late Safety Outcomes of using BioGlue in The CHINA Trial . Subjects enrolled in The CHINA Trial, from both the BioGlue and the control (TSR) group, will be invited to participate. Clinical data evaluating mortality, adverse events, and re-operation rates will be collected from subject's medical charts.

Official Title
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Multi-center, Randomized, Controlled Clinical Trial of BioGlue Surgical Adhesive as an Adjunct for Structural Repair and Hemostasis in Chinese Patients With Acute Type A Aortic Dissections.

Conditions
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Type A Aortic Dissection

Intervention / Treatment
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* Device: BioGlue Surgical Adhesive
* Other: Traditional Surgical Repair


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female subjects 18-70 years of age. Subject has a confirmed diagnosis of acute type A aortic dissection with subtype A2. Subject is willing and able to give written consent for the trial. If the subject is unconscious or under the influence of medications which render him or her unable to give fully informed consent, a guardian may provide informed consent for the subject regarding trial participation. Exclusion Criteria: Subjects with known allergy to albumin, bovine products, or glutaraldehyde. Subjects who have been treated with an investigational product who have not completed the entire follow-up period. Subjects who do not meet the eligibility criteria, including those who do not wish to participate or give informed consent for trial participation, will not be enrolled into the trial, and will be offered equivalent, non-trial surgical or other treatment, as judged appropriate by the investigator. Subjects with previous cardiac and aortic surgery. End stage malperfusion syndromes (i.e. end-organ failure such as coma, paraplegia, hemiplegia, intestinal necrosis, or hepatic failure). Subjects with Marfan syndrome or other connective tissue disorders. Previous chronic dissections resulting from non-cardiac surgery and/or trauma. Concomitant surgery of valve replacement (both in screening and intraoperative).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: BioGlue Surgical Adhesive<br>Subjects in the BioGlue group will receive BioGlue as an adjunct for traditional surgical repair of the sinus of Valsalva. | Device: BioGlue Surgical Adhesive<br>* BioGlue (produced by CryoLife in Kennesaw, GA) is a surgical adhesive with two components respectively purified bovine serum albumin (BSA) and Glutaraldehyde (their proportions are 4:1). Crosslinked bonds (covalent bonds) of Glutaraldehyde cross-link the protein on the surface of the tissue and the amino residue of the bovine serum albumin. BioGlue also adheres to the synthetic matrix material by a mechanical interlocking mechanism in the space of graft matrix.<br>|
| Other: Traditional Surgical Repair<br>Subjects in the control group will receive traditional surgical repair of the sinus of Valsalva. | Other: Traditional Surgical Repair<br>* Traditional surgical repair as determined by the surgeon<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful Closure of the False Lumen | Successful closure of the false lumen as determined by intraoperative TEE. With successful closure of the false lumen, a complete disappearance of the false lumen will be achieved. | This success can be visually confirmed intraoperatively with a TEE (binary yes/no expression for each subject) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful closure of the false lumen by CTA or TTE at discharge | Successful closure of the false lumen at discharge or at 20 days (+/- 10 days) post-operatively confirmed by CTA scan or Transthoracic Echocardiogram (TTE) scan if the subject is unable to have a CTA. | CTA or TTE scan at discharge or at 20 days (+/- 10 days) post-operatively for subjects with longer hospital stays. | 
| Time to repair the sinuses of Valsalva | During the operation the time to repair the sinuses of Valsalva will be recorded. | The time for repairing the sinuses of Valsalva will be documented intraoperatively. | 
| Evaluate the successful hemostasis at the anastomotic site | Hemostasis is assessed visually (i.e. lack of any observable extravascular bleeding) and is monitored until hemostasis is achieved at each applied anastomotic site. | The measurement begins intraoperatively after either BioGlue or Traditional Surgical Repair is applied to the anastomotic suture line(s) and the bypass cross clamp is released. | 
| Treatment failure of the aortic dissection repair site identified in The CHINA Trial which leads to either post-discharge mortality or re-operation. | Post-operative mortality and re-operation(s) will be collected from the subjects' medical charts retrospectively and during informed consent telephone notification. | The measurement begins at discharge and will end when the retrospective chart review is performed by the hospital (could be up to 3 years post-op) | 
| Proportion of subjects with device-related or procedure-related adverse events, determined by the investigators. | Post-operative adverse event(s) will be collected from the subjects' medical charts retrospectively. Assessment will only be performed on the surgical site from The CHINA Trial, defined as obliteration of the false lumen (BioGlue group) or repair of acute type A aortic dissection (control group) and anastomosis (both BioGlue and control groups). | The measurement begins at discharge and will end when the retrospective chart review is performed by the hospital (could be up to 3 years post-op). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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BioGlue Surgical Adhesive, Type A Aortic Dissection