Medtronic Transcatheter Aortic Valve Replacement (TAVR) Low Risk Bicuspid Study
Medtronic Transcatheter Aortic Valve Replacement (TAVR) Low Risk Bicuspid Study
The objective of the trial is to evaluate the procedural safety and efficacy of the Medtronic
 TAVR system in patients with bicuspid aortic anatomy and severe aortic stenosis at low risk
 for SAVR
Multi-center, prospective, single arm

 All subjects will be treated with a Medtronic TAVR system. Subject follow-ups will be
 conducted at pre and post-procedure, discharge, 30 days, 1 year, and annually through 10
 years
Inclusion Criteria:

 1. Severe aortic stenosis, defined as follows:

 1. For symptomatic patients:

 Aortic valve area ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), OR mean
 gradient ≥40 mmHg, OR Maximal aortic valve velocity ≥4.0 m/sec by transthoracic
 echocardiography at rest

 2. For asymptomatic patients:

 Very severe aortic stenosis with an aortic valve area of ≤1.0 cm2 (or aortic valve
 area index of ≤0.6 cm2/m2), AND maximal aortic velocity ≥5.0 m/sec, or mean gradient
 ≥60 mmHg by transthoracic echocardiography at rest, OR

 Aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), AND a mean
 gradient ≥40 mmHg or maximal aortic valve velocity ≥4.0 m/sec by transthoracic
 echocardiography at rest, AND an exercise tolerance test that demonstrates a limited
 exercise capacity, abnormal BP response, or arrhythmia OR

 Aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), AND mean
 gradient ≥40 mmHg, or maximal aortic valve velocity ≥4.0 m/sec by transthoracic
 echocardiography at rest, AND a left ventricular ejection fraction <50%.

 2. Patient is considered low risk for SAVR, where low risk is defined as predicted risk
 of mortality for SAVR <3% at 30 days per multidisciplinary local heart team
 assessment.

 3. Bicuspid aortic valve anatomy (all sub-types) confirmed by MDCT.

 4. The subject and the treating physician agree that the subject will return for all
 required post-procedure follow-up visits.

 Exclusion Criteria:

 1. Any condition considered a contraindication for placement of a bioprosthetic valve
 (eg, subject is indicated for mechanical prosthetic valve).

 2. Age less than 60 years

 3. A known hypersensitivity or contraindication to any of the following that cannot be
 adequately pre-medicated:

 1. aspirin or heparin (HIT/HITTS) and bivalirudin

 2. ticlopidine and clopidogrel

 3. Nitinol (titanium or nickel)

 4. contrast media

 4. Blood dyscrasias as defined: leukopenia (WBC <1000 mm3), thrombocytopenia (platelet
 count <50,000 cells/mm3), history of bleeding diathesis or coagulopathy, or
 hypercoagulable states.

 5. Ongoing sepsis, including active endocarditis.

 6. Any percutaneous coronary or peripheral interventional procedure with a bare metal
 stent or drug eluting stent performed within 30 days prior to screening committee
 approval.

 7. Multivessel coronary artery disease with a Syntax score >22 and/or unprotected left
 main coronary artery.

 8. Symptomatic carotid or vertebral artery disease or successful treatment of carotid
 stenosis within 10 weeks of Heart Team assessment.

 9. Cardiogenic shock manifested by low cardiac output, vasopressor dependence, or
 mechanical hemodynamic support.

 10. Recent (within 2 months of Heart Team assessment) cerebrovascular accident (CVA) or
 transient ischemic attack (TIA).

 11. Gastrointestinal (GI) bleeding that would preclude anticoagulation.

 12. Subject refuses a blood transfusion.

 13. Severe dementia (resulting in either inability to provide informed consent for the
 study/procedure, prevents independent lifestyle outside of a chronic care facility, or
 will fundamentally complicate rehabilitation from the procedure or compliance with
 follow-up visits).

 14. Estimated life expectancy of less than 24 months due to associated non-cardiac
 co-morbid conditions.

 15. Other medical, social, or psychological conditions that in the opinion of the
 investigator precludes the subject from appropriate consent or adherence to the
 protocol required follow-up exams.

 16. Currently participating in an investigational drug or another device study (excluding
 registries).

 17. Evidence of an acute myocardial infarction ≤30 days before the study procedure due to
 unstable coronary artery disease (WHO criteria).

 18. Need for emergency surgery for any reason.

 19. Subject is pregnant or breast feeding.

 20. Subject is legally incompetent, or otherwise vulnerable

 Anatomical exclusion criteria:

 21. Pre-existing prosthetic heart valve in any position.

 22. Severe mitral regurgitation amenable to surgical replacement or repair.

 23. Severe tricuspid regurgitation amenable to surgical replacement or repair.

 24. Moderate or severe mitral stenosis amenable to surgical replacement or repair.

 25. Hypertrophic obstructive cardiomyopathy with left ventricular outflow gradient.

 26. Prohibitive left ventricular outflow tract calcification.

 27. Sinus of Valsalva diameter unsuitable for placement of the self-expanding
 bioprosthesis

 28. Aortic annulus diameter of <18 or >30 mm.

 29. Significant ascending aortopathy requiring surgical repair

 30. Ascending aorta diameter > 4.5 cm

 For transfemoral or transaxillary (subclavian) access:

 31. Access vessel mean diameter <5.0 mm for Evolut 23R, 26R, or 29R mm TAV, or access
 vessel mean diameter <5.5 mm for Evolut 34R mm or Evolut PRO 23R, 26R, 29 R mm TAV.
 However, for transaxillary (subclavian) access in patients with a patent LIMA, access
 vessel mean diameter <5.5mm for Evolut 23R, 26R, or 29R mm TAV, or access vessel mean
 diameter <6.0 mm for the Evolut 34R or Evolut PRO TAV.