Edwards Lifesciences is committed to continued scientific advancement, and studies that investigate the safety and performance of new technologies.

COMMENCE trial video

Our trials aim to build upon one another by adding new variables which further challenge valve safety and efficacy. Our COMMENCE trial increased the patient population from the EU Feasibility trial, and the RESILIENCE trial is designed to look at different outcome measures to help further establish long-term valve durability.

Learn more about the current methodologies, promising results and conclusions of the various RESILIA tissue studies in the tabs below.

RESILIA tissue is building a track record of study data.

Start YearDescription
2010 Juvenile sheep study
2011 EU human feasibility study in Poland
2012 Aortic/mitral COMMENCE IDE study
2017 INSPIRIS RESILIA valve approved by FDA
2018 RESILIENCE study begins
Pannus Formation Study

Pannus Formation Study

Influence of tissue technology on pannus formation on bioprosthetic heart valves1

The objective of this publication is to study the effect of RESILIA tissue on pannus formation.

Methods

  • This publication reports the outcomes of two independent studies using a juvenile sheep model of mitral valve replacement with bovine pericardial tissue
    • In an 8-month study, valves with RESILIA tissue were compared to control valves with XenoLogiX treatment (XLX)
    • In a 5-month study, valves with RESILIA tissue were compared to control valves treated with the ThermaFix process (TFX)
  • Control valves were commercially available Carpentier-Edwards PERIMOUNT mitral valves, models 6900P, and 7000TFX. Test articles were the same models configured with RESILIA tissue
  • Explanted valves were examined macroscopically and histologically. Histological observations were made by an independent pathologist, blinded to group identity
  • Independent means of pannus quantification were employed in the two studies

Results

  • In the 5-month study, pannus area measured over the whole RESILIA tissue valves was significantly lower than that of the control valves, with a p-value of 0.010
  • For the 5-month study, a two sample t-test showed that the pannus on the atrial and ventricular side of each leaflet was significantly lower in test tissue samples (1.44 ± 1.52 mm²) compared to the controls (2.61 ± 2.15 mm²), with a p-value of 0.027
  • For the 8-month study, pannus measured in RESILIA tissue (0.095 ± 0.049 mm²) was significantly lower than control tissue (0.134 ± 0.066 mm²), with a  p-value of 0.002

Conclusions

  • RESILIA tissue valves were associated with reduced pannus formation when compared to control valves.
  • This technology has the potential to improve long term outcomes for patients
    For a more detailed overview of the Pannus Formation Study methodology and results please download the clinical summary.

    Pannus Formation Study Clinical Summary

    Pannus Formation Study Clinical Summary

    Juvenile Sheep Study

    A randomized assessment of an advanced tissue preservation technology in the juvenile sheep model2

    The aim of the study was to assess the effects of RESILIA tissue technology on valve function and durability in a chronic sheep model. The model was designed to mirror the accelerated calcification seen in younger humans.

    Methods

    • 45 juvenile sheep were randomized and either a PERIMOUNT mitral valve (6900P, control group) or the same valve design incorporating the RESILIA tissue preservation technology (test group) was implanted in the mitral position
    • All valves were 25 mm
    • A transthoracic echocardiography was performed at 1 week and at 8 months postoperatively
    • Necropsy was performed at 8 months, and the valves were examined radiographically (soft tissue radiograph), histologically (hematoxylin and eosin and Von Kossa staining), and chemically (calcium content)

    Results

    • 31 animals (14 controls and 17 test animals) remained in perfect condition during the 8-month follow-up period
    • Echocardiography at 1 week showed normal valve function in both groups
    • At 8 months, cardiac output increased significantly to the same extent in both groups (vs baseline; P < .01). The mean transvalvular pressure gradient also increased, but significantly more in the control group compared with the test group (P = .03)
    • Flow turbulence across the prosthesis was increased in the control valves compared with the test valves. The test valves had significantly less calcium content than the controls (1.9 ± 0.3 vs 6.8 ± 1.6 μg/mg; P = .002). This was confirmed by radiographic analysis and histology (see images below)
    A = PERIMOUNT Tissue Valve
    PERIMOUNT Tissue Valve
    B = RESILIA Tissue Valve
    RESILIA Tissue Valve

    No clinical data are available that evaluate the long-term impact of RESILIA tissue in patients.

    Conclusions

    This study demonstrates that the novel tissue preservation technology, when applied to the PERIMOUNT mitral valve, significantly improves hemodynamic and anti-calcification properties compared with the standard PERIMOUNT valve.

    For a more detailed overview of the Juvenile Sheep Study methodology and results, please see link to clinical paper details.
    Juvenile Sheep Study Clinical Paper Details
    EU Feasibility Study

    EU Feasibility Study

    5-year outcomes after aortic valve replacement with a novel RESILIA tissue bioprosthesis3

    The EU Feasibility study investigated the safety and performance in AVR patients of a bioprosthesis with RESILIA tissue. Absence of structural valve deterioration (SVD) and stable transvalvular gradients were observed through 5 years.

    Methods

    • Prospective, multicenter, single-arm, trial conducted at two sites
    • 133 patients underwent surgical AVR with an Edwards Pericardial Aortic Bioprosthesis with RESILIA tissue
      • Mean age 65.3 ± 13.5 years, with (26%) ≤ 60 years
      • 19 or 21 mm valve implanted in 43.6% of patients
    • Median follow up = 5 years; Total late follow-up time of 565.2 patient years (LPY)

    Results

    • Safety events
      • No cases of SVD 0%/LPY
      • Late all-cause mortality 3.2%/LPY
      • Late valve thrombosis 0.2%/LPY
      • Late endocarditis 0.2%/LPY
      • Late major paravalvular leak 0.0%/LPY
    • Stable hemodynamic performance observed at 5 years
      • Mean gradient was 14.8 ± 7.6 mmHg
      • Average EOA was 1.4 ± 0.5 cm2

    Conclusions

    The RESILIA tissue valve demonstrated excellent hemodynamic performance and safety outcomes over 5 years of follow-up.

    For a more detailed overview of the EU Feasibility Study methodology and results please download the Clinical Summary.

    EU Feasibility Study Clinical Summary

    EU Feasibility Study Clinical Summary
    COMMENCE Trial

    COMMENCE Trial

    Five-year outcomes of the COMMENCE Trial investigating aortic valve replacement with a novel tissue bioprosthesis4

    The COMMENCE trial is an FDA pivotal trial designed to evaluate the safety and effectiveness of a bioprosthetic valve with the novel RESILIA tissue.

    Methods

    • Prospective, multinational, multicenter (n = 27), single-arm, FDA Investigational Device Exemption trial
    • 689 patients underwent surgical AVR with the Edwards Pericardial Aortic Bioprosthesis with RESILIA tissue (model 11000A)
      • Mean age 66.9 ± 11.6 years, with 140 patients (21%) under 60 years
      • 71.8% male
      • 26% NYHA Class III/IV
      • Mean STS PROM 2.0 ± 1.8%
      • 59% isolated AVR
    • 2898 aggregate patient-years of follow up
      • Follow up: 4.3 ± 1.4 yrs (n = 471)

    Results

    • Safety endpoints, probability event-free at 5 years:
      • All-cause mortality, 89.2%
      • Major paravalvular leak, 99.5%
      • Endocarditis, 97.8%
    • Improved hemodynamic performance compared to baseline was observed through 5 years:
      • Mean gradient was 10.2 ± 4.6 at 1 year, 10.2 ± 4.5 at 2 years, and 10.8 ± 5.7 at 3 years, 11.1 ± 5.7 mmHg at 4 years, and 11.5 ± 6.0 at 5 years

    Conclusions

    • Favorable safety profile and stable hemodynamics of RESILIA tissue in a bovine aortic valve
    • No SVD through 5 yrs, stable gradients, and freedom from regurgitation all support durability over the observational period.
    • Follow-up continues on the long-term safety and effectiveness of this new tissue
    For a more detailed overview of the COMMENCE Trial methodology and results please download the Clinical Summary.

    COMMENCE Trial Hemodynamics Sub-Analysis

    Sub-analysis of the five-year outcomes of the COMMENCE aortic trial investigating patient and valve factors associated with longitudinal hemodynamic change and the study valve’s hemodynamic performance.5

    Methods

    • Patients underwent echocardiograms annually through 5 years of follow up; these were evaluated by a core laboratory.
    • Only patients with evaluable echo data (N=663) at any of the post-op visits were eligible for inclusion in this sub-analysis.
    • Longitudinal models were constructed to estimate the change in mean gradient and change in effective orifice area (EOA) separately over 5 years post-operatively.

    Results

    • Among various variables examined, only patient age at implant and valve size were statistically significantly associated with mean gradient change over 5 years.
      • Only valve size was found to be independently associated with a decrease in EOA.
    • In the multivariable model, mean gradient over 5 years rose 3.6 mmHg for the typical 55-yr old patient, 2.4 mmHg for the typical 65-yr old patient, and 1.6 mmHg for the typical 75-yr old patient.
      • Average 5-year change in EOA was between -0.27 cm2 and -0.29 cm2 for these ages.
    • In the multivariable model, mean gradient over 5 years rose between 0.9 mmHg and 2.7 mmHg for valve sizes between 21 mm and 27 mm, respectively.
      • Average 5-year change in EOA was between -0.19 cm2 and -0.30 cm2 for these valve sizes

    Conclusions

    • Only patient age and valve size were found to be independently associated with an increase in mean gradient over 5 years
    • The average 65-yr-old patient experienced an increase in mean gradient over 5 years of only 2.4 mmHg, and the average patient with a 23 mm valve size experienced an increase in gradient of only 1.8 mmHg
    • These results are encouraging for the potential durability of RESILIA tissue
    For a more detailed overview of the COMMENCE Trial Hemodynamics Sub-Analysis methodology and results, download the Clinical Summary.

    COMMENCE Trial Hemodynamics Sub-Analysis

    RESILIENCE Study Design

    RESILIENCE Study Design

    Study Design of the Prospective Non-Randomized Single Arm Multicenter Evaluation of the Durability of Aortic Bioprosthetic Valves with RESILIA Tissue in Subjects under 65 Years Old (RESILIENCE Trial)6

    The objective of the RESILIENCE trial is to determine the time to valve failure due to valve deterioration requiring re-intervention, as well as to collect/investigate early potential predictors of valve durability (e.g. calcification and hemodynamic deterioration) in RESILIA tissue. The RESILIENCE trial is the first prospective study to associate both clinical and imaging definitions of SVD with long-term (11 years) bioprosthetic valve durability.

    Methods

    • Multicenter, prospective, non-randomized, single-arm, observational trial
    • Up to 250 patients who previously underwent SAVR with a RESILIA tissue valve will be enrolled at up to 15 investigational centers across the United States and Europe
      • Includes patients <65 years old; at time of implant this is a population that is at high risk to develop SVD
      • First patient enrolled on November 21, 2018
      • Anticipated 3 year enrollment period
    • Patients undergo a TTE and non-contrast CT at 5, 7, 9, and 11 years post-valve implant (Figure 1).
      View Figure 1
    • The definition proposed by Dvir et al. includes four stages: Stage 0: no SVD; Stage 1: Morphological SVD; Stage 2: Moderate hemodynamic SVD; and Stage 3: Severe hemodynamic SVD

    Echocardiography and CT Core Laboratories will be responsible for independently evaluating TTEs and CTs submitted by trial sites and will report upon the primary and secondary outcomes of the trial.

    • The morphology and mobility of the bioprosthetic valve leaflets will be visually assessed in multiple views by 2D echocardiography
    • Non-contrast CT images will be acquired using a 64 slice or dual-source scanner
      • Valve leaflet calcification will be measured by the volumetric method that identifies calcium within the valve leaflets
      • The total volume of calcification over the 3 valve leaflets will be calculated and expressed in mm3

    The RESILIENCE trial will be the first prospective study that uses both clinical and imaging definitions of SVD to provide a comprehensive description of all stages of SVD and determine the long-term (11 years) durability of the RESILIA tissue in a aortic valve.

    For a more detailed overview of the RESILIENCE study methodology, please download the clinical summary.

    RESILIENCE Study Design Clinical Summary

    RESILIENCE Study Design Clinical Summary
    Featured Products

    Featured Products

    Explore our current RESILIA tissue products

    INSPIRIS RESILIA aortic valve

    INSPIRIS RESILIA aortic valve

    Learn more
    KONECT RESILIA aortic valved conduit

    KONECT RESILIA aortic valved conduit

    Learn more

    Contact us

    References:

    1. Tod reference is: TJ Tod et al. Cardiovasc Eng Technol 2021;12:418-25.
    2. Flameng W, et al. J Thorac Cardiovasc Surg. 2015;149:340–5.
    3. Bartus K et al. Eur J Cardiothorac Surg 2021;59:434-41.
    4. Bavaria JE et al. Ann Thorac Surg 2022 doi: https://doi.org/10.1016/j.athoracsur.2021.12.058
    5. Mumtaz MA, Bavaria JE, Griffith B, et al. Presented at the Society of Thoracic Surgeons Annual Meeting, January 2022.
    6. Pibarot P, et al. Structural Heart. 2020;4(1):46-52.

    Important Safety Information

    Important Safety Information

    RESILIA Tissue Devices

    Indications: INSPIRIS RESILIA Aortic Valve - For use in replacement of native or prosthetic aortic heart valves.

    KONECT RESILIA Aortic Valved Conduit - For use in replacement of native or prosthetic aortic heart valves and the associated repair or replacement of a damaged or diseased ascending aorta.

    Contraindications: There are no known contraindications with the use of these RESILIA tissue heart valve devices.

    Complications and Side Effects: Thromboembolism, valve thrombosis, hemorrhage, hemolysis, regurgitation, endocarditis, structural valve deterioration, nonstructural dysfunction, stenosis, arrhythmia, transient ischemic attack/stroke, congestive heart failure, myocardial infarction, any of which could lead to reoperation, explantation, permanent disability, and death. Additional adverse events potentially associated with the use of polyester vascular grafts in the KONECT RESILIA AVC include hemorrhage, thrombosis, graft infection, embolism, aneurysm, pseudoaneurysm, seroma, occlusion (anastomotic intimal hyperplasia), immunological reaction to collagen (shown to be a weak immunogen; infrequent, mild, localized and self-limiting), intimal peel formation, and conduit dilatation.

    Warnings: INSPIRIS RESILIA Aortic Valve - DO NOT ADJUST THE VALVE DIAMETER BY EXPANDING THE BAND PRIOR TO OR DURING IMPLANTATION OF THE SURGICAL VALVE. The expandable band is not designed to allow for compression or expansion during implantation of the surgical valve. This will cause damage to the valve and may result in aortic incompetence. DO NOT PERFORM STAND-ALONE BALLOON AORTIC VALVULOPLASTY PROCEDURES ON THIS VALVE FOR THE SIZES 19 – 25 mm as this may expand the valve causing aortic incompetence, coronary embolism or annular rupture. Valve-in-valve sizing in the INSPIRIS valve has only been tested with specific Edwards transcatheter heart valves. Use of other transcatheter valves may result in embolization of transcatheter devices anchored within or result in annular rupture.

    CAUTION: Federal (USA) law restricts these devices to sale by or on the order of a physician. See instructions for use for full prescribing information.

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