ALT-FLOW II Trial of the Edwards APTURE Transcatheter Shunt System
Purpose
This is a prospective, multi-center, randomized, sham-controlled clinical trial.
Condition
- Heart Failure
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- Symptomatic heart failure - A primary diagnosis of HFmrEF or HFpEF (LVEF > 40%), and - NYHA class II to ambulatory NYHA class IV (IVa), and - Documentation of at least one of the following from the date of initial informed consent: - ≥ 1 prior HF hospitalization(s) requiring IV HF therapy in the prior 12 months; AND/OR - EITHER BNP value > 35 pg/ml or > 125 pg/ml in permanent or long-term persistent atrial fibrillation; OR - NT-proBNP > 125 pg /ml or > 375 pg /ml in permanent or long-term persistent atrial fibrillation - There is objective evidence of cardiogenic pulmonary congestion based on hemodynamic criteria obtained by right heart catheterization (RHC) at exercise, and confirmed by hemodynamics core lab as: o As measured at end-expiration, pulmonary capillary wedge pressure (PCWP) at ≥ 20 Watts exercise (PCWP ≥ 20W) is elevated to ≥ 25 mmHg and exceeds [the corresponding] right atrial pressure (RAP) by ≥ 8 mmHg - In the judgment of the treating physician and the Central Screening Committee the patient is on GDMT for HFpEF/HFmrEF for >30 days prior to screening and baseline assessments, that is expected to be maintained without change for 6 months.
Exclusion Criteria
- Severe heart failure defined as one or more of the below: - ACC/AHA/ESC Stage D HF, non-ambulatory NYHA Class IV HF - If Body Mass Index (BMI) < 30, cardiac index < 2.0 L/min/m2 - If BMI ≥ 30, cardiac index < 1.8 L/min/m2 - Inotropic infusion (continuous or intermittent) within the past 6 months - Patient is on the cardiac transplant waiting list - Prior diagnosis of HF with reduced ejection fraction (HFrEF), including patients with improvement in LVEF to > 40% - Valve disease: - Degenerative mitral regurgitation > moderate - Functional or secondary mitral valve regurgitation defined as grade > moderate - Mitral stenosis > mild - Primary or secondary tricuspid valve regurgitation defined as grade > moderate - Aortic valve disease defined as aortic regurgitation grade > moderate or aortic stenosis > moderate - More than mild right ventricular (RV) dysfunction as determined by the echo core lab, taking into account the following available parameters: - Tricuspid annular plane systolic excursion (TAPSE) <1.4 cm, or - RV size ≥ LV size - Right ventricular ejection fraction (RVEF) < 35%; OR - Imaging or clinical evidence of congestive hepatopathy - Mean right atrial pressure (mRAP) > 15 mmHg at rest - Pulmonary vascular resistance (PVR) ≥ 5.0 WU - BMI ≥ 45 - Myocardial infarction (MI) and/or any therapeutic invasive, non-valvular cardiovascular procedure within past 3 months or current indication for coronary revascularization - Stroke, transient ischemic attack (TIA), deep vein thrombosis (DVT) or pulmonary embolus within the past 6 months - Renal insufficiency as determined by creatinine (sCr) level > 2.5 mg/dL or estimated glomerular filtration rate (eGFR) < 25ml/min/1.73 m2 by CKD-Epi equation; or currently requiring dialysis - Performance of the six-minute walk test (6MWT) with a distance < 50m OR > 450m - Active endocarditis or infection requiring intravenous antibiotics within 3 months
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental APTURE shunt + medical therapy |
|
|
|
Sham Comparator Sham + medical therapy |
|
Recruiting Locations
More Details
- Status
- Recruiting
- Sponsor
- Edwards Lifesciences
Detailed Description
The objectives of this trial are to assess the safety, performance, and effectiveness of the Edwards APTURE transcatheter shunt system when used for the treatment of patients with heart failure with preserved (HFpEF) or mildly reduced (HFmrEF) ejection fraction (LVEF >40%) who remain symptomatic despite guideline-directed medical therapy (GDMT)