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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/show/NCT03043404

Registration number
Ethics application status
Date submitted
Date registered
Date last updated

Titles & IDs
Public title
Performance and Safety of the Lotus™ Valve With a FLEXible Delivery System
Scientific title
REPRISE II FLEX: Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of LotuS™ ValvE With a FLEXible Delivery System - Confirmation of Performance and Safety
Secondary ID [1] 0 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Aortic Stenosis 0 0
Condition category
Condition code
Cardiovascular 0 0 0 0
Diseases of the vasculature and circulation including the lymphatic system

Study type
Description of intervention(s) / exposure
Treatment: Devices - Transcatheter aortic valve replacement

Experimental: Lotus Valve Flex System - Transcatheter aortic valve replacement (TAVR) with Lotus Valve FLEX System

Treatment: Devices: Transcatheter aortic valve replacement
TAVR with Lotus Valve Flex System

Intervention code [1] 0 0
Treatment: Devices
Comparator / control treatment
Control group

Primary outcome [1] 0 0
Technical success - defined as successful vascular access, delivery and deployment of the Lotus Valve and successful retrieval of the delivery system; and correct positioning of a single Lotus Valve in the proper anatomical location; reported as percent of subjects.
Timepoint [1] 0 0
immediately post-procedure
Secondary outcome [1] 0 0
Mean aortic valve pressure gradient and effective orifice area - as measured by echocardiography and assessed by an independent core laboratory
Timepoint [1] 0 0
at discharge or 7 days post-procedure (whichever comes first)
Secondary outcome [2] 0 0
Device performance - defined as successful repositioning of the Lotus Valve if repositioning is attempted; and successful retrieval of the Lotus Valve if retrieval is attempted; and grade of paravalvular aortic regurgitation, as measured by echocardiography and assessed by an independent core laboratory
Timepoint [2] 0 0
at discharge or 7 days post-procedure (whichever comes first)

Key inclusion criteria
- 1. Subject is =70 years of age

- 2. Subject has documented calcific native aortic valve stenosis with an initial aortic
valve area (AVA) of <1.0 cm2 (or AVA index of <0.6 cm2/m2) and either a mean pressure
gradient >40 mm Hg or a jet velocity >4 m/s, as measured by echocardiography

- 3. Subject has a documented aortic annulus size between =20 and =27 mm based on
pre-procedure diagnostic imaging

- 4. Symptomatic aortic valve stenosis with NYHA Functional Class = II

- 5. Subject is considered high risk for surgical valve replacement based on at least
one of the following:

1. Society of Thoracic Surgeons (STS) score =8%, AND/OR

2. Agreement by the heart team (which must include an in-person evaluation by an
experienced cardiac surgeon) that subject is at high operative risk of serious
morbidity or mortality with surgical valve replacement

- 6. Heart team (which must include an experienced cardiac surgeon) assessment that the
subject is likely to benefit from valve replacement.

- 7. Subject (or legal representative) understands the study requirements and the
treatment procedures, and provides written informed consent.

- 8. Subject, family member, and/or legal representative agree(s) and subject is capable
of returning to the study hospital for all required scheduled follow up visits.
Minimum age
70 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
1. Subject has a congenital unicuspid or bicuspid aortic valve.

2. Subject with an acute myocardial infarction within 30 days of the index procedure
(defined as Q-wave MI or non-Q-wave MI with total CK elevation = twice normal in the
presence of CK-MB elevation and/or troponin elevation).

3. Subject has had a cerebrovascular accident or transient ischemic attack within the
past 6 months, or has any permanent neurologic defect prior to study enrollment.

4. Subject is on dialysis or has serum creatinine level >3.0 mg/dL or 265 µmol/L.

5. Subject has a pre-existing prosthetic heart valve (aortic or mitral) or a prosthetic
ring in any position.

6. Subject has =3+ mitral regurgitation, =3+ aortic regurgitation or =3+ tricuspid
regurgitation (i.e., subject cannot have more than moderate mitral, aortic or
tricuspid regurgitation).

7. Subject has a need for emergency surgery for any reason.

8. Subject has a history of endocarditis within 12 months of index procedure or evidence
of an active systemic infection or sepsis.

9. Subject has echocardiographic evidence of intra-cardiac mass, thrombus or vegetation.

10. Subject has Hgb <9 g/dL, platelet count <50,000 cells/mm3 or >700,000 cells/mm3, or
white blood cell count <1,000 cells/mm3.

11. Subject requires chronic anticoagulation therapy (warfarin) and cannot tolerate
concomitant therapy with either aspirin or clopidogrel.

Note: Subjects who require chronic anticoagulation must be able to be treated
additionally with either aspirin or clopidogrel. An alternative P2Y12 inhibitor may be
prescribed if subject is allergic to or intolerant of clopidogrel.

12. Subject has active peptic ulcer disease or gastrointestinal bleed within the past 3
months, other bleeding diathesis or coagulopathy or will refuse transfusions.

13. Subject has known hypersensitivity to contrast agents that cannot be adequately
pre-medicated, or has known hypersensitivity to aspirin, all thienopyridines, heparin,
nickel, tantalum, titanium, or polyurethanes.

14. Subject has a life expectancy of less than 12 months due to non-cardiac, co-morbid
conditions based on the assessment of the investigator at the time of enrollment.

15. Subject has hypertrophic obstructive cardiomyopathy.

16. Subject has any therapeutic invasive cardiac procedure (including balloon aortic
valvuloplasty) within 30 days prior to the index procedure (except for pacemaker
implantation which is allowed).

17. Subject has untreated coronary artery disease, which in the opinion of the treating
physician is clinically significant and requires revascularization.

18. Subject has documented left ventricular ejection fraction <30%.

19. Subject is in cardiogenic shock or has hemodynamic instability requiring inotropic
support or mechanical support devices.

20. Subject has severe peripheral vascular disease (including aneurysm defined as maximal
luminal diameter >5 cm or with documented presence of thrombus, marked tortuosity,
narrowing of the abdominal aorta, severe unfolding of the thoracic aorta or thick [>5
mm], protruding or ulcerated atheroma in the aortic arch) or symptomatic carotid or
vertebral disease.

21. Femoral artery lumen of <6.0 mm for subjects requiring 23 mm valve size or <6.5 mm for
subjects requiring 27 mm valve size, or severe iliofemoral tortuosity or calcification
that would prevent safe placement of the introducer sheath.

22. Current problems with substance abuse (e.g., alcohol, etc.).

23. Subject is participating in another investigational drug or device study that has not
reached its primary endpoint.

24. Subject has untreated conduction system disorder (e.g., Type II second degree
atrioventricular block) that in the opinion of the treating physician is clinically
significant and requires a pacemaker implantation.

Study design
Purpose of the study
Allocation to intervention
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Single group
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 0 0
Prince Charles Hospital - Chermside
Recruitment hospital [2] 0 0
Monash Heart - Clayton
Recruitment postcode(s) [1] 0 0
4032 - Chermside
Recruitment postcode(s) [2] 0 0
3168 - Clayton

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Boston Scientific Corporation

Ethics approval
Ethics application status

Brief summary
To confirm the acute performance and safety of the Lotus™ Valve Flex System for transcatheter
aortic valve replacement (TAVR) in symptomatic patients with severe calcific aortic stenosis
who are considered high risk for surgical valve replacement.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 0 0
Ian T Meredith, MD, PhD
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries

Summary results
Other publications