PROphylactic triCuspID Annuloplasty in Patients With Dilated Tricuspid Annulus

NCT ID: NCT03129737

Last Updated: 2017-06-28

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-17

Study Completion Date

2020-06-30

Brief Summary

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Patients elected to undergo mitral valve surgery (either repair or replacement) with less equal than moderate (≤+2) tricuspid regurgitation and dilated tricuspid annulus (\>21mm/m2) at preoperative echocardiography will be screened. Consenting patients fulfilling all inclusion and exclusion criteria will be included in the study and assigned to elective mitral valve replacement or repair with or without concomitant tricuspid annuloplasty in a 1:1 fashion, using a blocked randomization scheme balanced within center.

Detailed Description

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The present study is designed as a prospective, multicentre, multinational, randomized, 2-arm parallel group trial. Participating centres are selected based on previous experience with the surgical technique and standardised echo imaging. Each center is expected to contribute 20 to 40 patients over a 12-month enrolment period.

Patients elected to undergo mitral valve surgery (either repair or replacement) with less equal than moderate (≤+2) tricuspid regurgitation and dilated tricuspid annulus (\>21mm/m2) at preoperative echocardiography will be screened. Consenting patients fulfilling all inclusion and exclusion criteria will be included in the study and assigned to elective mitral valve replacement or repair with or without concomitant tricuspid annuloplasty in a 1:1 fashion, using a blocked randomization scheme balanced within center.

After discharge patients will be assessed at 1 month (phone contact), 6 month and 1-year after surgery.

Conditions

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Tricuspid (Valve) Insufficiency (Rheumatic)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Tricuspid valve annuloplasty

Concomitant tricuspid valve annuloplasty in patients with tricuspid annulus dilatation (\>21mm /m2) with or without TR≤ moderate in pts undergoing mitral valve surgery

Group Type EXPERIMENTAL

Mitral valve surgery

Intervention Type PROCEDURE

Mitral valve repair is preferred whenever technically feasible over valve replacement. Annuloplasty may be used as sole therapy or in conjunction with other repair maneuvers to support the reconstruction and reinforce the annulus as well as prevent future annular dilatation. The mitral regurgitation secondary to myxomatous degeneration is prolapse of the middle scallop of the posterior leaflet result from chordal rupture or chordal elongation. Quadrangular resection of the involved middle scallop of the posterior leaflet combined with a posterior mitral annuloplasty is the best way to handle this situation. Chordae replacement could be used also to treat flail/prolapse of the anterior leaflet. Annuloplasty is always doing in mitral valve repair to stabilize and reshape the annulus.

Tricuspid valve annuloplasty

Intervention Type PROCEDURE

Depending on the extent of the valve disease, there is the possibility to perform valve repair. In mitral valve reference center the rate of repair will reach 100%. In many patients with mitral valve regurgitation, tricuspid valve will be insufficient or the annulus dilated. Tricuspid annuloplasty ring will be helpful to treat dilation by reshaping, or to treat the regurgitant diseases. The ring will be secured and sutured to the native annulus by U-stitches.

Mitral valve repair

No concomitant tricuspid valve annuloplasty in patients with tricuspid annulus dilatation (\>21mm/m2) with or without TR ≤ moderate in pts undergoing mitral valve surgery

Group Type ACTIVE_COMPARATOR

Mitral valve surgery

Intervention Type PROCEDURE

Mitral valve repair is preferred whenever technically feasible over valve replacement. Annuloplasty may be used as sole therapy or in conjunction with other repair maneuvers to support the reconstruction and reinforce the annulus as well as prevent future annular dilatation. The mitral regurgitation secondary to myxomatous degeneration is prolapse of the middle scallop of the posterior leaflet result from chordal rupture or chordal elongation. Quadrangular resection of the involved middle scallop of the posterior leaflet combined with a posterior mitral annuloplasty is the best way to handle this situation. Chordae replacement could be used also to treat flail/prolapse of the anterior leaflet. Annuloplasty is always doing in mitral valve repair to stabilize and reshape the annulus.

Interventions

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Mitral valve surgery

Mitral valve repair is preferred whenever technically feasible over valve replacement. Annuloplasty may be used as sole therapy or in conjunction with other repair maneuvers to support the reconstruction and reinforce the annulus as well as prevent future annular dilatation. The mitral regurgitation secondary to myxomatous degeneration is prolapse of the middle scallop of the posterior leaflet result from chordal rupture or chordal elongation. Quadrangular resection of the involved middle scallop of the posterior leaflet combined with a posterior mitral annuloplasty is the best way to handle this situation. Chordae replacement could be used also to treat flail/prolapse of the anterior leaflet. Annuloplasty is always doing in mitral valve repair to stabilize and reshape the annulus.

Intervention Type PROCEDURE

Tricuspid valve annuloplasty

Depending on the extent of the valve disease, there is the possibility to perform valve repair. In mitral valve reference center the rate of repair will reach 100%. In many patients with mitral valve regurgitation, tricuspid valve will be insufficient or the annulus dilated. Tricuspid annuloplasty ring will be helpful to treat dilation by reshaping, or to treat the regurgitant diseases. The ring will be secured and sutured to the native annulus by U-stitches.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Patients undergoing mitral valve surgery (either repair or replacement) with less/equal than moderate (≤+2) tricuspid regurgitation and dilated tricuspid annulus (\>21mm/m2 BSA) at preoperative echocardiography and fulfilling the following selection criteria:


1. Written informed consent
2. Degenerative mitral valve disease
3. \> 18 years old

Exclusion Criteria

1. Presence of structural or organic tricuspid valve disease
2. urgent operation
3. presence of pacemaker leads through the tricuspid annulus
4. acute endocarditis or other organic valve diseases
5. previous surgical procedure
6. Severe TR
7. Associated cardiac procedure
8. NYHA class IV
9. Severe COPD (GOLD class 3,4)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ettore Sansavini Health Science Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Maria Salomone, MD

Role: STUDY_DIRECTOR

Fondazione Ettore Sansavini per la Ricerca Scientifica ONLUS

Locations

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Casa di Cura Montevergine

Mercogliano, Avellino, Italy

Site Status NOT_YET_RECRUITING

ICLAS

Rapallo, Genova, Italy

Site Status NOT_YET_RECRUITING

Maria Cecilia Hospital

Cotignola, Ravenna, Italy

Site Status RECRUITING

Anthea Hospital

Bari, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Santa Maria

Bari, , Italy

Site Status NOT_YET_RECRUITING

Città di Lecce Hospital

Lecce, , Italy

Site Status RECRUITING

Maria Eleonora Hospital

Palermo, , Italy

Site Status ACTIVE_NOT_RECRUITING

Maria Pia Hospital

Torino, , Italy

Site Status NOT_YET_RECRUITING

Countries

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Italy

Central Contacts

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Khalil Fattouch, MD

Role: CONTACT

+39 328 8105584

Maria Salomone, MD

Role: CONTACT

+39 389 5635731

Facility Contacts

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Carlo Zebele, MD

Role: primary

Role: backup

Luigi Martinelli, MD

Role: primary

Role: backup

Mauro Del Giglio, MD

Role: primary

Role: backup

Giuseppe Speziale, MD,PhD

Role: primary

Role: backup

Domenico Paparella, MD, PhD

Role: primary

Role: backup

Renato Gregorini, MD

Role: primary

Role: backup

Chiara Comoglio, MD

Role: primary

Role: backup

Other Identifiers

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ESREFO 18

Identifier Type: -

Identifier Source: org_study_id

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