ClinicalTrials.gg
RecruitingNCT07309029PROTECT-TAVRUpdated Dec 30, 2025

Pre-Emptive LAVA-ECMO for Complex High-Risk TAVR

An observational study in Severe Aortic Stenosis, Cardiogenic Shock and Cardiogenic Shock, ECMO, sponsored by Atlantic Health System. Recruiting at 2 sites in United States. Open to participants aged 18 Years to 100 Years. Per ClinicalTrials.gov, last updated 2025-12-30.

Sponsored by Atlantic Health System · Observational

Study type
Observational
Model
Cohort
Time perspective
Other
Enrollment
30
Ages
18 Years to 100 Years
Sex
All
01

Study summary

The goal of this clinical trial is to evaluate the feasibility, effectiveness, and safety of pre-emptive left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) in patients undergoing complex and high-risk transcatheter aortic valve replacement (TAVR). These patients include adults with severe aortic stenosis who are hemodynamically unstable or at risk of instability due to anatomical complexity. The main questions it aims to answer are:

  1. Does pre-emptive LAVA-ECMO reduce the incidence of in-hospital death, intraprocedural cardiac arrest, or emergent cardiac surgery?
  2. What are the safety outcomes related to LAVA-ECMO, including major vascular, bleeding, or cardiac structural complications? -This is a single-arm, prospective, multi-center study with no comparison group.

Participants will:

  • Be screened for eligibility based on hemodynamic status and anatomical complexity
  • Undergo pre-emptive LAVA-ECMO cannulation prior to or during TAVR
  • Receive follow-up assessments at 30 days and 1 year, including clinical evaluation and echocardiography
02

Conditions studied

  • Severe Aortic Stenosis
  • Cardiogenic Shock
  • Cardiogenic Shock, ECMO
  • Trans-catheter Aortic Valve Implantation

Keywords

  • severe aortic stenosis
  • cardiogenic shock
  • TAVR
03

In context

Aortic Valve Stenosis

1,025 studies on the registry are indexed under Aortic Valve Stenosis; 293 are open to participants now.

This study's planned enrollment of 30 is below the median of 200 across 435 observational studies indexed under Aortic Valve Stenosis.

Browse Aortic Valve Stenosis studies →

Lead sponsor

Atlantic Health System is the lead sponsor of 64 studies on the registry; 12 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 100 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Study participants will be recruited from Atlantic Health System hospitals and affiliated centers. Eligible individuals are adult patients diagnosed with severe native aortic stenosis or degenerated bioprosthetic aortic valves who are scheduled for transcatheter aortic valve replacement (TAVR). Patients are identified through institutional clinical practices and referrals, including those admitted to the cardiac care unit with signs of hemodynamic instability or anatomical complexity. Recruitment may include critically ill patients who are sedated or intubated, with consent obtained from legally authorized representatives when necessary.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

- Patients are required to have either a Class III hemodynamic status OR type B or type C anatomical complexity with Class II (at risk) hemodynamics (Figure 2).

  • Hemodynamic Criteria

    • Major Criteria (Class III)

      • Systolic blood pressure \<90 mmHg or MAP\<60 mmHg
      • Need for vasopressors or inotropes to maintain MAP>60 mmHg
      • Evidence of end-organ damage including: acute kidney injury, liver dysfunction, elevated lactate or altered mentation
    • Minor Criteria (Class II)

      • \<35%
      • Pulmonary hypertension (pulmonary artery systolic pressure >60 mmHg) with right ventricular dysfunction
      • Pulmonary capillary wedge pressure >30 mmHg
  • Anatomic criteria

    • Major Criteria (Type C)

      • Native or valve-in-valve TAVR requiring single-leaflet modification for a large area of myocardium at risk (e.g. patients with large or dominant left circulation)
      • Native or valve-in-valve TAVR requiring dual-leaflet modification
      • Severe bioprosthetic aortic regurgitation
      • Severe 3-vessel coronary artery disease not amenable to revascularization (SYNTAX score >33)
    • Minor Criteria (Type B)

      • Native or valve-in-valve TAVR requiring single-leaflet modification
      • Severe commissural misalignment requiring leaflet modification
      • High-risk for coronary occlusion not amenable to leaflet modification
      • Critical low-flow low-gradient aortic stenosis (defined as an estimated aortic valve area ≤0.5 cm2)

Exclusion criteria

Exclusion Criteria:

  • Age \<18 or pregnant

    • General absolute to TAVR
    • Severe peripheral artery disease with infeasibility for veno-arterial extracorporeal membrane oxygenation implantation.
    • Contraindications to transeptal cannulation (e.g. pre-existing interatrial septum occluder device).
    • Pre-existing Impella treatment.
    • Onset of shock >12 hours.
    • Preceding cardiac arrest with prolonged resuscitation (>40 minutes).
    • Other severe concomitant disease with \<6 months.
    • Participation in another trial with an intervention.
    • Any class I hemodynamic status
    • Type A anatomical complexity with class I or II hemodynamic status
Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

05

Study design

Observational model
Cohort
Time perspective
Other
Enrollment
30 participants (estimated)
Target follow-up
30 Days
Patient registry
Yes

Interventions

  • DeviceLeft Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO)

    Pre-emptive use of LAVA-ECMO involves transseptal cannulation of the left atrium to provide mechanical circulatory support and left ventricular unloading during high-risk transcatheter aortic valve replacement (TAVR). The device is placed prior to or at the start of the TAVR procedure in patients with unstable hemodynamics or complex anatomical features.

06

What researchers measure

Primary outcomes

  1. Primary Efficacy Endpoint: Composite of in-hospital death, intraprocedural resuscitated cardiac arrest or emergent cardiac surgery.

    Time frame: From enrollment through hospital discharge (up to 30 days post-procedure)

Secondary outcomes

  1. Primary Safety Endpoint: Composite of VARC-3 major vascular complications, type 3 or 4 VARC-3 bleeding complications or major cardiac structural complications related to left atrial cannulation.

    The primary safety endpoint includes a composite of major vascular, bleeding and cardiac structural complications according to the VARC-3 criteria. For the purpose of this trial the component of the primary safety endpoint will be differentiated between TAVR-related (e.g. associated with the vascular access used for TAVR, valve delivery system or valve implant) and LAVA-ECMO-related (e.g. associated with LAVA-ECMO cannulation including transseptal puncture).

    Time frame: From enrollment through hospital discharge (up to 30 days post-procedure)

07

Study locations

2 of 2 sites recruiting
  • Center for Structural Heart Disease Henry Ford Hospital
    Detroit, Michigan 48202, United States
    Recruiting
  • Valve and Structural Heart Center Morristown Medical Center
    Morristown, New Jersey 07960, United States
    Recruiting
08

References and documents

Publications

  • VARC-3 WRITING COMMITTEE:; Genereux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021 Jun 1;77(21):2717-2746. doi: 10.1016/j.jacc.2021.02.038. Epub 2021 Apr 19. PubMed 33888385 ↗
  • Golzarian H, Thiel A, Hempfling G, Otto M, Otto T, Shappell E, Racer L, Martz D, Recker-Herman CM, Laird A, Cole WC, Sirak J, Patel SM. Severe aortic insufficiency-induced cardiogenic shock treated with left atrial VA-ECMO and emergent valve-in-valve TAVR. ESC Heart Fail. 2023 Dec;10(6):3718-3724. doi: 10.1002/ehf2.14561. Epub 2023 Oct 27. PubMed 37890858 ↗
  • Giustino G, O'Neill BP, Wang DD, Frisoli T, Fang JX, Engel-Gonzalez P, Lee J, Fadel R, O'Neill WW, Villablanca PA. Feasibility and safety of transcaval venoarterial extracorporeal membrane oxygenation in severe cardiogenic shock. EuroIntervention. 2024 Apr 15;20(8):e511-e513. doi: 10.4244/EIJ-D-23-01046. No abstract available. PubMed 38629421 ↗
  • Fraccaro C, Karam N, Mollmann H, Bleiziffer S, Bonaros N, Teles RC, Carrilho Ferreira P, Chieffo A, Czerny M, Donal E, Dudek D, Dumonteil N, Esposito G, Fournier S, Hassager C, Kim WK, Krychtiuk KA, Mehilli J, Pregowski J, Stefanini GG, Ternacle J, Thiele H, Thielmann M, Vincent F, von Bardeleben RS, Tarantini G. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EuroIntervention. 2023 Oct 23;19(8):634-651. doi: 10.4244/EIJ-D-23-00473. PubMed 37624587 ↗
  • Villablanca PA, Al-Darzi W, Boshara A, Hana A, Basir M, O'Neill B, Frisoli T, Lee J, Wang DD, O'Neill WW. Left Atrial Venoarterial Extracorporeal Membrane Oxygenation for Patients in Cardiogenic Shock and Acute Aortic Regurgitation. JACC Cardiovasc Interv. 2022 Oct 24;15(20):2112-2114. doi: 10.1016/j.jcin.2022.08.015. Epub 2022 Sep 28. No abstract available. PubMed 36265949 ↗
  • Sabharwal A, Tsiouris A, Slaughter MS, Lemor A, Jeyakumar AKC, Protos A, Hernandez GA. Left Atrial-Veno Arterial Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Endocarditis-Related Acute Severe Aortic Regurgitation. ASAIO J. 2024 Apr 1;70(4):e61-e64. doi: 10.1097/MAT.0000000000002077. Epub 2023 Nov 1. PubMed 37913501 ↗
  • Lemor A, Basir MB, O'Neill BP, Cowger J, Frisoli T, Lee JC, Wang DD, Alaswad K, O'Neill W, Villablanca PA. Left Atrial-Veno-Arterial Extracorporeal Membrane Oxygenation: Step-By-Step Procedure and Case Example. Struct Heart. 2022 Oct 31;6(6):100117. doi: 10.1016/j.shj.2022.100117. eCollection 2022 Nov. PubMed 37288119 ↗
  • Lama von Buchwald C, Gonzalez PE, O'Neill B, Wang DD, Frisoli T, O'Neill WW, Villablanca PA. Percutaneous Retrieval of an Aortic Valve Vegetation Causing Severe Regurgitation and Cardiogenic Shock. JACC Cardiovasc Interv. 2023 May 22;16(10):1301-1303. doi: 10.1016/j.jcin.2023.03.027. Epub 2023 May 3. No abstract available. PubMed 37140503 ↗
  • Fang JX, Giustino G, Apostolou D, Lee JC, Wang DD, Engel Gonzalez P, O'Neill BP, Frisoli TM, O'Neill WW, Villablanca PA. LAVA-ECMO-Supported Dual-Transcatheter Aortic and Mitral Valve-in-Valve Replacement in Cardiogenic Shock. JACC Case Rep. 2024 Oct 2;29(19):102564. doi: 10.1016/j.jaccas.2024.102564. eCollection 2024 Oct 2. PubMed 39484326 ↗
  • Chiang M, Gonzalez PE, O'Neill BP, Lee J, Frisoli T, Wang DD, O'Neill WW, Villablanca PA. Left Atrial Venoarterial Extracorporeal Membrane Oxygenation for Acute Aortic Regurgitation and Cardiogenic Shock. JACC Case Rep. 2022 Mar 2;4(5):276-279. doi: 10.1016/j.jaccas.2021.12.030. eCollection 2022 Mar 2. PubMed 35257102 ↗
  • Chiang M, Gonzalez PE, Basir MB, O'Neill BP, Lee J, Frisoli T, Wang DD, O'Neill WW, Villablanca PA. Modified Transcaval Left Atrial Venoarterial Extracorporeal Membrane Oxygenation Without Preplanning Contrast CT: Step-by-Step Guide. JACC Cardiovasc Interv. 2022 Aug 22;15(16):e181-e185. doi: 10.1016/j.jcin.2022.05.033. Epub 2022 Jul 13. No abstract available. PubMed 35981853 ↗
  • Nair RM, Chawla S, Alkhalaileh F, Abdelghaffar B, Bansal A, Higgins A, Lee R, Rampersad P, Khot UN, Jaber WA, Reed GW, Cremer PC, Menon V. Characteristics and Outcomes of Patients With Valvular Cardiogenic Shock. JACC Adv. 2024 Oct 4;3(11):101303. doi: 10.1016/j.jacadv.2024.101303. eCollection 2024 Nov. PubMed 39429239 ↗
  • Burkhoff D, Sayer G, Doshi D, Uriel N. Hemodynamics of Mechanical Circulatory Support. J Am Coll Cardiol. 2015 Dec 15;66(23):2663-2674. doi: 10.1016/j.jacc.2015.10.017. PubMed 26670067 ↗
  • Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013 Oct 31;369(18):1726-34. doi: 10.1056/NEJMra1208943. No abstract available. PubMed 24171518 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Start is estimated for Jan 2026; primary completion for May 2027, 16 months later.

Of 205 non-industry observational studies under Aortic Valve Stenosis, half reached primary completion within 45 months of starting (the median), counting those still running; a quarter within 23 and three quarters within 120. This study's planned 16 months is below that.

Counting every sponsor, half of 242 studies reached it within 42 months; a quarter within 23 and three quarters within 86.

How these figures are worked out, and which studies are left out of them.

Registered
Nov 24, 2025
First posted
Dec 30, 2025
StartEst.
Jan 1, 2026
Primary completionEst.
May 30, 2027
CompletionEst.
Jun 30, 2027
Last update
Dec 30, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 30, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07309029
Lead sponsor
Atlantic Health System
Responsible party
Gennaro Giustino (MD, Atlantic Health System) — Principal investigator
First posted
Dec 30, 2025
Start date
Jan 1, 2026 (estimated)
Primary completion
May 30, 2027 (estimated)
Completion
Jun 30, 2027 (estimated)
Last update
Dec 30, 2025

Study contacts

Gennaro Giustino, MD
Contact
Gennaro.Giustino@atlantichealth.org
9739718858
Pedro Villablanca, MD
Contact
pvillab1@hfhs.org

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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