--- title: Treating Severe Mitral Valve Annular or Valvular Calcification Using Shockwave Balloon SMARTWAVE nct_id: NCT06952374 overall_status: RECRUITING phase: NA sponsor: Prince of Wales Hospital, Shatin, Hong Kong study_type: INTERVENTIONAL primary_condition: Mitral Annulus Calcification countries: Hong Kong canonical_url: "https://parkinsonspathways.com/agent/trials/NCT06952374.md" clinicaltrials_gov: "https://clinicaltrials.gov/study/NCT06952374" ct_last_update_post_date: 2025-04-30 last_seen_at: "2026-05-12T06:05:11.685Z" source: ClinicalTrials.gov (mirrored, no enrichment) --- # Treating Severe Mitral Valve Annular or Valvular Calcification Using Shockwave Balloon SMARTWAVE **Official Title:** Mitral Valve Lithotripsy Using the SMARTWAVE Balloon for Severe Mitral Annular or Valvular Calcification (SMART-MAC): First in Human Study **NCT ID:** [NCT06952374](https://clinicaltrials.gov/study/NCT06952374) ## Key Facts - **Status:** RECRUITING - **Phase:** NA - **Study Type:** INTERVENTIONAL - **Target Enrollment:** 10 - **Lead Sponsor:** Prince of Wales Hospital, Shatin, Hong Kong - **Collaborators:** Peijia Medical Technology (Suzhou) Co., Ltd. - **Conditions:** Mitral Annulus Calcification, Rheumatic Heart Disease - **Start Date:** 2025-03-08 - **Completion Date:** 2027-03-31 - **CT.gov Last Update:** 2025-04-30 ## Brief Summary Mitral stenosis (MS) is a heavily symptomatic valvular heart disease. Common causes of MS included chronic rheumatic heart disease (CRHD) and mitral annular calcification (MAC). Current guideline recommends percutaneous balloon mitral valvuloplasty (PBMV) being the first line intervention for rheumatic MS with favorable anatomy. However, severely calcified mitral valve (i.e. those with Wilkins scores\>8) makes the mitral valve non-pliable and carries high risk of severe mitral regurgitation (MR) (4-19%) with conventional balloon valvuloplasty. MAC is an increasingly recognized disease associated with atherosclerotic risk factors, and a well-recognized valve morphology that responses poorly with PBMV. Besides, conventional open-heart surgery for MAC-associated mitral valve dysfunction carries high mortality. Transcatheter mitral valve replacement with valve-in-MAC has become an alternative in treating these patients. However, valve-in-MAC is not always feasible and still carries operative and 30-day mortality. Intravascular lithotripsy is an approved adjunct interventional therapy in treating calcified lesions to facilitate stenotic lesion opening in peripheral vascular disease and coronary artery disease. The off-label use of current peripheral lithotripsy balloon in mitral valve as a compassionate treatment or as an adjunct treatment before mitral balloon valvuloplasty and transcatheter mitral valve replacement has been reported with success . A possible mechanism is that lithotripsy preferentially impacts hard tissue, disrupts calcium, and leaves soft tissue undisturbed, improving valve pliability, preventing leaflet damage, and making subsequent valvuloplasty safer. However, the off-label use of multiple peripheral lithotripsy balloons in mitral valve is technically complicated. SmartWave balloon was specifically designed lithotripsy balloon for calcified aortic stenosis. This first-in-human study aims to apply the SmartWave lithotripsy balloon in treating calcified mitral stenosis due to MAC or severely calcified rheumatic mitral valve. ## Detailed Description Mitral stenosis (MS) is a heavily symptomatic valvular heart disease. Common causes of MS included chronic rheumatic heart disease (CRHD) and mitral annular calcification (MAC). Current guideline recommends percutaneous balloon mitral valvuloplasty (PBMV) being the first line intervention for rheumatic MS with favorable anatomy. However, severely calcified mitral valve (i.e. those with Wilkins scores\>8) makes the mitral valve non-pliable and carries high risk of severe mitral regurgitation (MR) (4-19%) with conventional balloon valvuloplasty. MAC is an increasingly recognized disease associated with atherosclerotic risk factors, and a well-recognized valve morphology that responses poorly with PBMV. Besides, conventional open-heart surgery for MAC-associated mitral valve dysfunction carries high mortality. Transcatheter mitral valve replacement with valve-in-MAC has become an alternative in treating these patients. However, valve-in-MAC is not always feasible and still carries operative and 30-day mortality. Intravascular lithotripsy is an approved adjunct interventional therapy in treating calcified lesions to facilitate stenotic lesion opening in peripheral vascular disease and coronary artery disease. The off-label use of current peripheral lithotripsy balloon in mitral valve as a compassionate treatment or as an adjunct treatment before mitral balloon valvuloplasty and transcatheter mitral valve replacement has been reported with success . A possible mechanism is that lithotripsy preferentially impacts hard tissue, disrupts calcium, and leaves soft tissue undisturbed, improving valve pliability, preventing leaflet damage, and making subsequent valvuloplasty safer. However, the off-label use of multiple peripheral lithotripsy balloons in mitral valve is technically complicated. SmartWave balloon was specifically designed lithotripsy balloon for calcified aortic stenosis. This first-in-human study aims to apply the SmartWave lithotripsy balloon in treating calcified mitral stenosis due to MAC or severely calcified rheumatic mitral valve. ## Eligibility - **Minimum age:** 18 Years - **Sex:** ALL - **Healthy Volunteers:** No ``` Inclusion Criteria: * Age \>18 and * Able to give procedure and study consent and * Severe symptomatic mitral stenosis (MVA \<1.5cm\^2 derived by 3D planimetry or continuity equation or pressure half time) and * Presence of mitral annular calcification or * CRHD with severe leaflet calcification with Wilkins score \>8 Exclusion Criteria: * Baseline \> moderate MR * Intracardiac thrombus as visualized by TEE * Pregnant patients. Female patients of childbearing potential must have a negative pregnancy test (per site standard test) within 7 days prior to index procedure. * Active infection with bacteremia * Current participation in another investigational drug or device study ``` ## Arms - **SmartWave** (EXPERIMENTAL) ## Interventions - **SmartWave Lithotripsy balloon** (DEVICE) — ntravascular lithotripsy is an approved adjunct interventional therapy in treating calcified lesions to facilitate stenotic lesion opening in peripheral vascular disease and coronary artery disease. The off-label use of current peripheral lithotripsy balloon in mitral valve as a compassionate treatment or as an adjunct treatment before mitral balloon valvuloplasty and transcatheter mitral valve replacement has been reported with success . A possible mechanism is that lithotripsy preferentially impacts hard tissue, disrupts calcium, and leaves soft tissue undisturbed, improving valve pliability, preventing leaflet damage, and making subsequent valvuloplasty safer. ## Primary Outcomes - **Improvement in mitral valve area** _(time frame: Post-OP 6 and 12 month)_ — Immediate and sustained improvement in mitral valve area (MVA \>1.5cm\^2) without significant worsening of MR (\> moderate) - **Absence of peri-procedural complication** _(time frame: At and peri-procedure)_ — Absence of peri-procedural complication (death, stroke, myocardial infarction, cardiac tamponade, conversion to open heart) defined according to the Mitral Valve Academic Research Consortium ## Secondary Outcomes - **Hemodynamic changes** _(time frame: Intra-operation)_ - **Mitral valve calcification level** _(time frame: Baseline and post-procedure up to 1 year)_ - **Symptom status change (New York Heart Aassociation functional class)** _(time frame: Baseline,Post-OP 1 month, 3 month, 6 month, 12 month)_ - **Symptom status change (By Kansas City Cardiomyopathy Questionnaire-12)** _(time frame: Baseline,Post-OP 1 month, 3 month, 6 month, 12 month)_ - **Debris histology** _(time frame: peri-operation)_ - **NTproBNP** _(time frame: baseline, post-operation, Post-OP 1, 3, 6, 12 month)_ - **Lung Fluid** _(time frame: baseline, Post-OP 1, 3, 6, 12 month)_ - **Major Adverse Cardiac Event** _(time frame: 6 month and 12 month post-operation)_ ## Locations (1) - Prince of Wales Hospital, Shatin, New Territories, Hong Kong — _RECRUITING_ ## Recent Field Changes (last 30 days) - `eligibility.sex` — added _(2026-05-12)_ - `status.overallStatus` — added _(2026-05-12)_ - `status.primaryCompletionDate` — added _(2026-05-12)_ - `status.completionDate` — added _(2026-05-12)_ - `status.lastUpdatePostDate` — added _(2026-05-12)_ - `design.phases` — added _(2026-05-12)_ - `design.enrollmentCount` — added _(2026-05-12)_ - `eligibility.criteria` — added _(2026-05-12)_ - `eligibility.minAge` — added _(2026-05-12)_ - `outcomes.primary` — added _(2026-05-12)_ - `outcomes.secondary` — added _(2026-05-12)_ - `armsInterventions.arms` — added _(2026-05-12)_ - `armsInterventions.interventions` — added _(2026-05-12)_ - `sponsor.lead` — added _(2026-05-12)_ - `sponsor.collaborators` — added _(2026-05-12)_ - `results.hasResults` — added _(2026-05-12)_ - `locations.prince of wales hospital|shatin|new territories|hong kong` — added _(2026-05-12)_ --- *Canonical: https://parkinsonspathways.com/agent/trials/NCT06952374.md* *Source data (authoritative): https://clinicaltrials.gov/study/NCT06952374* *This page is a raw mirror with no AI summary, no editorial enrichment, and no Parkinson's-specific filtering.*