Long Term Follow Up for CTSN Mitral Valve Repair Studies

NCT ID: NCT03066050

Last Updated: 2025-07-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Total Enrollment

368 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-05-03

Study Completion Date

2027-07-31

Brief Summary

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This study is a continuation of two previous studies --- the Severe Ischemic Mitral Regurgitation (SMR) Trial (NCT00807040) and the Moderate Ischemic Mitral regurgitation (MMR) Trial (NCT00806988) --- to learn more about patients' health 5-10 years after their mitral valve surgeries. The investigators will collect long-term health information on SMR and MMR trial participants using electronic medical records, patient and/or family input, public records, and healthcare- and vital status-related databases.

Detailed Description

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This study is a continuation of two CTSN randomized trials --- the Severe Ischemic Mitral Regurgitation (SMR) Trial (NCT00807040) and the Moderate Ischemic Mitral regurgitation (MMR) Trial (NCT00806988) --- for the purpose of assessing the long-term outcomes of the index surgical therapies. Key clinical outcomes will be collected utilizing electronic medical records, patient and/or family input, public records, and healthcare- and vital status-related databases. Extended follow-up data will be obtained on up to 199 SMR and 270 MMR trial participants, who were alive at their 2-year follow-up evaluation. Patients will be followed for a minimum of 5 years and up to 10 years after randomization (the time of index surgical procedure). This follow-up data collection will be conducted by the Cardiothoracic Surgical Trials Network (CTSN) primarily utilizing the minimal PHI necessary to link data obtained from the MMR and SMR trials to other healthcare- and/or vital status-related databases.

Because the design of surgical trials for ischemic mitral regurgitation that would use mortality as a primary endpoint requires the enrollment of thousands of patients, the selected primary endpoint for the CTSN SMR and MMR trials was an echocardiographic measure of left ventricular remodeling. Secondary endpoints included, among others, survival, adverse events, readmissions and costs over a 2-year period. The SMR trial showed no difference in left ventricular reverse remodeling, but the rate of moderate or severe mitral regurgitation recurrence was significantly higher with mitral valve repair, resulting in more heart failure-related adverse events and cardiovascular admissions. Longer-term follow-up will be critical to assess whether this observed trend amongst SMR patients will continue and whether a survival difference will manifest over time. In moderate ischemic mitral regurgitation, mitral valve repair provided a more durable correction of mitral regurgitation than coronary artery bypass grafting (CABG) alone, but repair did not improve survival or reduce overall adverse events or readmissions, and was associated with an early hazard of neurological and supraventricular arrhythmic events. Longer-term follow-up of MMR patients will provide insights into whether the higher degree of recurrent mitral regurgitation with CABG alone will be associated with differences in adverse events, readmissions and survival. Additionally, the benefits of alternative surgical treatments for ischemic mitral regurgitation, which have differential upfront risks and costs, will likely extend beyond 2 years. Cost-effectiveness analysis will delineate the long-term cost-benefit trade-offs between mitral valve repair versus replacement for SMR, and of CABG with repair versus CABG alone for MMR, which should inform surgical decision making, and examine how differences in life expectancy and risk profiles of different patient groups affect cost-effectiveness over time. This extended follow-up should provide important clinical and health policy insights.

Conditions

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Mitral Valve Insufficiency Coronary Artery Disease

Study Design

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Observational Model Type

OTHER

Study Time Perspective

OTHER

Study Groups

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SMR MV Repair

This group of patients had been randomized in the SMR study to mitral valve repair with annuloplasty ring.

MV Repair

Intervention Type OTHER

Participants underwent mitral valve repair with annuloplasty and a sub-valvular procedure for severe tethering.

MV Replacement

This group of patients had been randomized in the SMR study to mitral valve replacement.

MV Replacement

Intervention Type OTHER

Participants underwent mitral valve replacement and complete preservation of the sub-valvular apparatus.

MMR MV Repair

This group of patients had been randomized in the MMR study to mitral valve repair with annuloplasty ring.

MV Repair

Intervention Type OTHER

Participants underwent mitral valve repair with annuloplasty and a sub-valvular procedure for severe tethering.

CABG

This group of patients had been randomized in the MMR study to receive CABG

CABG

Intervention Type OTHER

Participants underwent coronary artery bypass grafting

Interventions

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MV Repair

Participants underwent mitral valve repair with annuloplasty and a sub-valvular procedure for severe tethering.

Intervention Type OTHER

MV Replacement

Participants underwent mitral valve replacement and complete preservation of the sub-valvular apparatus.

Intervention Type OTHER

CABG

Participants underwent coronary artery bypass grafting

Intervention Type OTHER

Other Intervention Names

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Mitral Valve Repair Mitral Valve Replacement Coronary Artery Bypass Grafting

Eligibility Criteria

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Inclusion Criteria

* Randomized patients in the MMR and SMR trials who were still alive at 2 years after the index cardiac surgical intervention

Exclusion Criteria

* Patients participating in the MMR and SMR trials who withdrew consent prior to the 2-year follow-up evaluation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Icahn School of Medicine at Mount Sinai

OTHER

Sponsor Role lead

Responsible Party

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Annetine Gelijns

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Annetine C Gelijns, PhD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Richard Weisel, MD

Role: STUDY_CHAIR

Toronto General Hospital

Locations

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University of Southern California

Los Angeles, California, United States

Site Status

Emory University

Atlanta, Georgia, United States

Site Status

University of Maryland

Baltimore, Maryland, United States

Site Status

Suburban Hospital

Bethesda, Maryland, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Montefiore Einstein Heart Center

The Bronx, New York, United States

Site Status

Mission Hospital

Asheville, North Carolina, United States

Site Status

Duke University

Durham, North Carolina, United States

Site Status

East Carolina Heart Institute

Greenville, North Carolina, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

Ohio State University

Columbus, Ohio, United States

Site Status

University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Baylor Research Institute

Plano, Texas, United States

Site Status

University of Virginia Health Systems

Charlottesville, Virginia, United States

Site Status

Inova Heart and Vascular Institute

Falls Church, Virginia, United States

Site Status

University of Alberta Hospital

Edmonton, Alberta, Canada

Site Status

Sunnybrook Health Science Centre

Toronto, Ontario, Canada

Site Status

Saint Michael's Hospital

Toronto, Ontario, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status

Centre Hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status

Hôpital du Sacré-Cœur de Montréal

Montreal, Quebec, Canada

Site Status

Institut Universitaire de Cardiologie de Quebec (Hopital Laval)

Québec, , Canada

Site Status

Countries

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United States Canada

Other Identifiers

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U01HL088942

Identifier Type: NIH

Identifier Source: secondary_id

View Link

GCO 08-1078-00012

Identifier Type: -

Identifier Source: org_study_id

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