Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery
The purpose of the research is to determine whether repairing a tricuspid valve (TV) in patients with mild to moderate tricuspid regurgitation (TR), at the time of planned mitral valve surgery (MVS), would improve the heart health of those who receive it compared to those who do not.
At this point, the medical community is split in their opinion on whether surgeons should routinely repair mild to moderate TR in patients who are undergoing planned mitral valve surgery, and this study will answer this question.
|Mild Tricuspid Regurgitation Moderate Tricuspid Regurgitation Tricuspid Regurgitation||Procedure: TV Annuloplasty Procedure: MVS|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery|
- Degree of TR Repair [ Time Frame: 24 Months ]Effectiveness of TR Repair assessed by a composite of death, reoperation for TR, or progression of TR from baseline by two grades or the presence of severe TR at 24 months.
- MACCE [ Time Frame: up to 24 Months ]Major Adverse Cardiac and Cerebrovascular Events (MACCE) is defined as a non-weighted composite score comprised of the following components: Death, Stroke, and Serious heart failure events
- NYHA Classification [ Time Frame: up to 24 Months ]Functional status will be assessed by the New York Heart Association (NYHA) Classification scale which ranges from 1 (no physical limitations) to 4 (severe limitation of physical activity).
- Diuretic Use [ Time Frame: up to 24 Months ]The diuretic requirements of patients will be assessed.
- Six Minute Walk Test [ Time Frame: up to 24 Months ]The total distance walked in six minutes will be assessed.
- Degree of TR [ Time Frame: up to 24 Months ]Degree of TR assessed by echocardiography, categorized according to American Society of Echocardiography guidelines as none/mild/moderate/severe.
- Right Ventricular size [ Time Frame: up to 24 Months ]Right ventricular (RV) size assessed by echocardiography.
- Degree of RV function [ Time Frame: up to 24 Months ]Degree of RV function assessed by echocardiography as normal, mildly impaired, moderately impaired, severely impaired.
- Peak tricuspid annular velocity [ Time Frame: up to 24 Months ]Degree of RV function assessed by peak tricuspid annular velocity
- Tricuspid annular peak systolic excursion (TAPSE) [ Time Frame: up to 24 Months ]Degree of RV function assessed by TAPSE
- Right ventricular fractional area change (RVFAC) [ Time Frame: up to 24 Months ]Degree of RV function assessed by RVFAC
- Pulmonary Artery Pressure [ Time Frame: up to 24 Months ]Pulmonary artery pressure assessed by echocardiography.
- Right Ventricular Volume [ Time Frame: up to 24 Months ]RV Volume as measured by transthoracic 3D echocardiography.
- SF-12 [ Time Frame: up to 24 Months ]Quality of Life assessed by SF-12. A measure of perceived health (health-related quality of life [QoL]) that describes the degree of general physical health status and mental health distress. Higher scores indicate higher levels of health.
- Kansas City Cardiomyopathy Questionnaire (KCCQ) [ Time Frame: up to 24 Months ]Quality of Life assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). KCCQ is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life, in which higher scores reflect better health status.
- EuroQoL (EQ-5D) [ Time Frame: up to 24 Months ]Quality of Life assessed by EuroQoL (EQ-5D) - a standardised instrument for use as a measure of health outcome. Higher scores indicate higher levels of health.
- Survival [ Time Frame: up to 60 Months ]Incidence of participants alive
- Length of Index Hospitalization [ Time Frame: average 30 days ]
- Readmission [ Time Frame: up to 60 months ]Incidence of readmissions
- Reoperations [ Time Frame: up to 60 months ]Incidence of reoperations
- Economic Measures (Inpatient costs) [ Time Frame: up to 60 months ]Inpatient costs will be measured through the collection of hospital billing.
- Serious adverse events [ Time Frame: 60 months ]Safety as measured by frequency of serious adverse events.
- AV-Block requiring pacemaker implantation [ Time Frame: 60 months ]Safety as measured by frequency of AV-Block requiring pacemaker implantation.
- New-onset atrial fibrillation [ Time Frame: 60 months ]Safety as measured by frequency new-onset atrial fibrillation.
|Study Start Date:||May 2016|
|Estimated Study Completion Date:||May 2021|
|Estimated Primary Completion Date:||May 2018 (Final data collection date for primary outcome measure)|
Active Comparator: MVS Alone
Participants will undergo mitral valve surgery alone.
MVS will be performed using standard surgical techniques
Active Comparator: MVS + TV Annuloplasty
Patients will undergo mitral valve surgery and tricuspid valve annuloplasty.
Procedure: TV Annuloplasty
TV Annuloplasty will be performed using standard surgical techniquesProcedure: MVS
MVS will be performed using standard surgical techniques
The tricuspid valve controls the flow of blood in your heart between the right ventricle and the right atrium. TR is a condition where the valve does not close fully when it is supposed to and blood can then leak back into the right atrium. When TR becomes severe, surgery is usually performed to correct it. The purpose of the research is to determine whether repairing a tricuspid valve in patients with mild to moderate TR, at the time of planned mitral valve surgery, would improve the heart health of those who receive it compared to those who do not. There are no new or "experimental" procedures being tested in this study: both the mitral valve procedure and the tricuspid valve repair procedure are well established surgeries and are regularly performed together in patients who have severe TR. The available evidence addressing this issue is not definite: it is based on less rigorous methods of investigation, and the results have been conflicting. The study being proposed here will use rigorous scientific methods and should result in a very high level of certainty about what surgical treatment is best for patients with your condition.
This study will enroll people scheduled for mitral valve surgery with mild to moderate tricuspid regurgitation.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02675244
|Contact: Ellen Moquete, RNfirstname.lastname@example.org|
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|Principal Investigator:||Annetine C. Gelijns, PhD||Icahn School of Medicine at Mount Sinai|
|Study Chair:||Richard Weisel, MD||Toronto General Hospital|