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PARTNER II Trial: S3iCAP
Trial ID: NCT02687035
Following completion of enrollment in the PARTNER II SAPIEN 3 intermediate risk trial, this trial provided continued access to treatment for subjects with severe aortic stenosis who were at intermediate surgical risk.
The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves: Continued Access Program for SAPIEN 3 Intermediate Risk (S3iCAP)
Rajesh Dash, MD PhD; Director of SSATHI & CardioClick
Associate Professor of Medicine (Cardiovascular Medicine)
D. Craig Miller, M.D.
Thelma and Henry Doelger Professor of Cardiovascular Surgery, Emeritus
Alan Yeung, MD
Li Ka Shing Professor in Cardiology
1. Patients must be covered by Medicare. This will enable Edwards to link to the CMS
database for long term follow-up through 5 years. No other insurance provider will be
2. Assessment of intermediate surgical risk defined as STS 4-8% or heart team assessment
of intermediate risk factors.
3. Patient has senile degenerative aortic valve stenosis with echocardiographically
derived criteria: mean gradient > 40 mmHg or jet velocity greater than 4.0 m/s and an
initial aortic valve area (AVA) of < 0.8 cm2 or indexed EOA < 0.5 cm2/m2. Qualifying
echo must be within 60 days of the date of the procedure.
4. Aortic valve annulus area range (273mm2-680 mm2) per 3D imaging (echo, CT, or MRI).
5. Patient is symptomatic from his/her aortic valve stenosis, as demonstrated by NYHA
Functional Class II or greater.
6. The heart team agrees (and verified in the case review process) that valve
implantation will likely benefit the patient.
7. Heart team agrees (a priori) on treatment strategy for concomitant coronary disease
8. The study patient or the study patient's legal representative has been informed of the
nature of the study, agrees to its provisions and has provided written informed
consent as approved by the Institutional Review Board (IRB) of the respective clinical
9. The study patient agrees to comply with all required post-procedure follow-up visits
including annual visits through 5 years and analysis close date visits, which will be
conducted as a phone follow-up.
1. Heart team assessment of inoperability (including examining cardiac surgeon).
2. Evidence of an acute myocardial infarction ≤ 1 month (30 days) before the intended
treatment [(defined as: Q wave MI, or non-Q wave MI with total CK elevation of CK-MB ≥
twice normal in the presence of MB elevation and/or troponin level elevation (WHO
3. Aortic valve is a congenital unicuspid or congenital bicuspid valve, or is
4. Mixed aortic valve disease (aortic stenosis and aortic re-regurgitation with
predominant aortic regurgitation >3+).
5. Pre-existing mechanical or bioprosthetic valve in any position.
6. Complex coronary artery disease:
1. Unprotected left main coronary artery
2. Syntax score > 32 (in the absence of prior revascularization)
7. Any therapeutic invasive cardiac procedure resulting in a permanent implant that is
performed within 30 days of the index procedure (unless part of planned strategy for
treatment of concomitant coronary artery disease). Implantation of a permanent
pacemaker or ICD is not considered exclusion criteria.
8. Any patient with a balloon valvuloplasty (BAV) < 30 days of the procedure (unless BAV
is a bridge to procedure after a qualifying ECHO).
9. Patients with planned concomitant surgical or transcatheter ablation for atrial
10. Leukopenia (WBC < 3000 cell/mL), acute anemia (Hgb < 9 g/dL), thrombocytopenia (Plt <
11. Hypertrophic cardiomyopathy with or without obstruction (HOCM).
12. Hemodynamic or respiratory instability requiring inotropic support, mechanical
ventilation or mechanical heart assistance within 30 days of screening evaluation.
13. Need for emergency surgery for any reason.
14. Severe ventricular dysfunction with LVEF < 20%.
15. Echocardiographic evidence of intracardiac mass, thrombus or vegetation.
16. Active upper GI bleeding within 3 months (90 days) prior to procedure.
17. A known contraindication or hypersensitivity to all anticoagulation regimens, or
inability to be anticoagulated for the study procedure.
18. Native aortic annulus size < 16 mm or > 28mm as measured by echocardiogram.
19. Clinically (by neurologist) or neuroimaging confirmed stroke or transient ischemic
attack (TIA) within 6 months (180 days) of the procedure.
20. Renal insufficiency (creatinine > 3.0 mg/dL) and/or renal replacement therapy at the
time of screening.
21. Estimated life expectancy < 24 months (730 days) due to carcinomas, chronic liver
disease, chronic renal dis-ease or chronic end stage pulmonary disease.
22. Expectation that patient will not improve despite treatment of aortic stenosis.
23. Significant aortic disease, including marked tortuosity (hyperacute bend), aortic arch
atheroma [especially if thick (> 5 mm), protruding or ulcerated] or narrowing
(especially with calcification and surface irregularities) of the abdominal or
thoracic aorta, severe "unfolding" and tortuosity of the thoracic aorta.
24. Iliofemoral vessel characteristics that would preclude safe placement of 14F or 16F
introducer sheath such as severe obstructive calcification, severe tortuosity or
min-imum average vessel size less than 5.5 mm. (Transfem-oral).
25. Currently participating in an investigational drug or an-other device study. Note:
Trials requiring extended fol-low-up for products that were investigational, but have
since become commercially available, are not considered investigational trials.
26. Active bacterial endocarditis within 6 months (180 days) of procedure.
27. Evidence of intracardiac mass, thrombus, vegetation, active infection or endocarditis.
28. Inability to tolerate anticoagulation/antiplatelet therapy.
29. For transfemoral approach only: Femoro-iliac vessels < 5.5 mm for the 23 mm and the 26
mm system and < 6.0 mm for the 29 mm system.
device: SAPIEN S3 valve
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Craig Miller, MD