Pivot Bridge device for massive functional tricuspid regurgitation: safety and effectiveness

The Study for Evaluation of Acute Phase Safety and Efficacy of 'Pivot Bridge' to Short-term Treat Functional Tricuspid Regurgitation

This trial will test whether the Pivot Bridge spacer is safe and improves symptoms in adults with massive functional tricuspid regurgitation who have already been on medical therapy for at least one month.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 20 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Tau-MEDICAL Co., Ltd. (Industry-sponsored)
• Locations: 4 sites (Daegu, Dalseo-gu and 3 other locations)
• Trial ID: NCT07385625 on ClinicalTrials.gov

What this trial studies

The trial implants the Pivot Bridge spacer into adults with massive (4+) functional tricuspid regurgitation and tracks acute safety and clinical outcomes. It uses a self‑controlled case series design comparing each participant's fixed medical therapy period before device placement with the period after implantation, with endpoints such as procedure success and clinical success. Key imaging and anatomical requirements include right ventricle enlargement relative to the left ventricle and an annular diameter ≥40 mm, and participants must have had at least one month of diuretic/pharmacologic therapy. Procedures and follow‑up are being conducted at tertiary hospitals in South Korea.

Who should consider this trial

Good fit: Ideal candidates are adults (≥18 years) with massive (4+) functional TR who remain symptomatic (NYHA class II or higher) after at least one month of medical therapy, have RV enlargement and an annular diameter ≥40 mm, and are approved by the Heart Team.

Not a fit: Patients with primary (organic) tricuspid valve disease, less-than-massive TR, unsuitable cardiac anatomy for the device, active infection, or very limited life expectancy may not receive benefit from this device.

Why it matters

Potential benefit: If successful, the Pivot Bridge could reduce TR severity and symptoms, potentially lowering hospitalizations and improving patients' quality of life.

How similar studies have performed: Other transcatheter tricuspid repair approaches, including edge‑to‑edge systems and early spacer concepts, have shown promising reductions in TR and symptoms in selected patients, but spacer-specific data are still limited and early.

Eligibility criteria

Inclusion Criteria:

Subjects who meet all of the following criteria will be enrolled

* Adults aged 18 years or older at the time of screening
* Subjects who have received appropriate medical treatment (diuretics/medical therapy) for tricuspid regurgitation for at least 1 month prior to participation in this clinical trial
* Subjects who, at the screening visit, are assessed by transthoracic echocardiography (TTE) to have functional tricuspid regurgitation severity of Massive (4+) or greater, as defined by Tricuspid Valve Academic Research Consortium classification, and who have clinical symptoms corresponding to New York Heart Association (NYHA) functional class II or higher
* Subjects who, at the screening visit, are found on TTE or cardiac computed tomography (CT) to have a right ventricle (RV) larger than the left ventricle (LV)
* Subjects who, at the screening visit, are found on cardiac CT to have an annular diameter of 40 mm or greater
* Subjects for whom the Heart Team, consisting of at least one cardiologist (specialist in cardiology) and at least one cardiac surgeon, has determined that surgical treatment for isolated Tricuspid Regurgitation is required
* Subjects who voluntarily decide to participate in this clinical trial and provide written informed consent on the subject consent form
* Subjects who are able to understand and comply with the investigator's instructions and participate throughout the entire clinical trial period

Exclusion Criteria:

Subjects who meet any of the following criteria will be excluded

* Subjects in whom thrombus or embolic material is identified on echocardiography or cardiac computed tomography (CT) performed at the screening visit
* Subjects who have uncorrected coagulation disorders as shown by clinical laboratory tests performed at the screening visit
* Subjects who cannot use anticoagulant agents
* Subjects who, prior to participation in this clinical trial, have experienced major bleeding due to the use of anticoagulants (minor bleeding such as controllable epistaxis does not apply) requiring treatment, or who have had severe anemia necessitating hospitalization
* Subjects who, prior to participation in this clinical trial, have had devices such as an implantable cardioverter defibrillator (ICD) or a pacemaker implanted
* Subjects who, based on echocardiography and cardiac CT performed at the screening visit, are judged by the investigator to have anatomical structures unsuitable for implantation of the investigational medical device
* Subjects who, based on clinical laboratory tests performed at the screening visit, have a platelet count of ≤80,000/µL
* Subjects who, based on echocardiography performed at the screening visit, have pulmonary hypertension with TR Vmax ≥3.5 m/s
* Subjects who, based on echocardiography performed at the screening visit, have left ventricular ejection fraction (LVEF) \<50%
* Subjects who, within 3 months prior to participation in this clinical trial, have had active gastrointestinal bleeding or have undergone gastrointestinal procedures (subjects with a risk of gastrointestinal bleeding)
* Subjects who, within 30 days prior to participation in this clinical trial, have a history of cerebrovascular accident (CVA) or transient ischemic attack (TIA)
* Subjects who, within 30 days prior to participation in this clinical trial, have a history of myocardial infarction (MI)
* Subjects with active infective endocarditis requiring antibiotic therapy
* Subjects with severe terminal illnesses (e.g., malignant tumors, end-stage pulmonary disease, end-stage liver disease, end-stage renal failure)
* Subjects who, based on echocardiography performed at the screening visit, have moderate or severe aortic, pulmonary, or mitral stenosis
* Subjects who, based on echocardiography performed at the screening visit, are found to have calcification of the tricuspid valve leaflets that would affect the procedure
* Subjects who, based on echocardiography performed at the screening visit, are found to have masses, thrombi, or proliferative lesions in the right heart system, femoral vein, or inferior vena cava
* Subjects who, within 30 days prior to participation in this clinical trial, have participated in another clinical trial
* Pregnant or lactating women, and women planning to become pregnant during the study period
* Women of childbearing potential who are not using medically acceptable methods of contraception
* Subjects who, in addition to the above, are deemed by the investigator to have clinically significant findings that make them inappropriate for participation in this trial

Where this trial is running

Daegu, Dalseo-gu and 3 other locations

• Keimyung University Dongsan Hospital — Daegu, Dalseo-gu, South Korea (Recruiting)
• Pusan National University Yangsan Hospital — Yangsan, Gyeongsangnam-do, South Korea (Recruiting)
• Yonsei University Health System, Severance Hospital — Seoul, Seodaemun-gu, South Korea (Recruiting)
• Asan Medical Center — Seoul, Songpa-gu, South Korea (Recruiting)

Study contacts

• Principal investigator: Geu-Ru Hong, MD, PhD — Yonsei University Health System, Severance Hospital
• Study coordinator: June-Hong Kim, MD, PhD

Conditions Tricuspid Regurgitation Functional; Tricuspid Regurgitation; SPACER; Pivot Bridge