- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04078867
Outcome of MC3 Ring Annuloplasty for Functional Tricuspid Regurgitation
Outcome of MC3 Ring Annuloplasty for Moderate and Severe Functional Tricuspid Regurgitation Associated With Rheumatic Mitral Valve Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study evaluated early and midterm outcomes after operations for TV repair which were performed at our institution, between January 2016 and December 2018. The mean follow-up duration was 18.84±9.90 months (range: 3-33 months). The study included 105 patients who underwent repair for FTR during mitral valve replacement for rheumatic valve disease. There were 82 patients underwent suture (DeVega) repair and 23 patients underwent ring annuloplasty using Edward MC3 incomplete 3D ring. The indications of surgery for FTR were: (1) severe TR; or (2) moderate TR with annular dilatation greater than 40 mm and/or preoperative systolic pulmonary artery pressure (SPAP) >50 mmHg. We excluded patients with non-rheumatic mitral disease, combined mitral and aortic valve replacement, mitral valve repair, concomitant coronary artery or aortic surgery, mild or organic tricuspid regurgitation, emergency surgery, reoperations or missed data. Based on echocardiographic data, the severity of TR was graded as: 0 (no TR), 1+ (mild TR), 2+ (mild to moderate TR), 3+ (moderately severe TR), or 4+ (severe).
The type of tricuspid valve repair was chosen in according to surgeon's preference and echocardiographic criteria of TV. The DeVega repair was performed when the patient had minimal annular dilation and lower severity of pulmonary hypertension, while ring annuloplasty was performed in patients with severe tricuspid annular dilation and severe pulmonary hypertension. The DeVega repair was performed on a beating heart using pledget-supported two 4-0 polypropylene running parallel sutures. The MC3 ring annuloplasty was performed through right atriotomy using cardiopulmonary bypass and cardioplegic arrest. The ring size was determined after measurement of the length of the attachments of the tricuspid septal leaflet (the distance between the anteroseptal and septoposterior commissures) or the surface area of the anterior leaflet. The chosen ring was undersized by at least one size. The ring was implanted from the anteroseptal commissure to the middle of the septal leaflet. A series of 8 to10 mattress sutures with a 2-0 Ethibond multifilament suture were made on the tricuspid annulus starting from the center of the septal annulus to the anteroseptal commissure in the counter-clockwise direction, to avoid the atrioventricular conduction tissue. Thereafter, the sutures were placed through the sewing ring of the prosthesis , followed by lowering and securing of the ring to the annulus The collected pre-operative data included age, sex, New York Heart Association (NYHA) functional class, , and the type of preoperative mitral valve disease. The primarily assessed post-operative outcome was residual TR (≥ moderate TR; ≥ grade +2). Other assessed pre- and post-operative parameters included NYHA functional class, and echocardiographic data regarding grade of TR, SPAP, tricuspid annulus (TA) diameter, tricuspid annular plane systolic excursion (TAPSE), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), and left ventricular ejection fraction (LVEF).
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Rheumatic mitral valve disease
- Surgery for mitral valve replacement
- Severe functional tricuspid regurgitation
- Moderate functional tricuspid regurgitation with annular dilatation > 40 mm
- Moderate functional tricuspid regurgitation with preoperative systolic pulmonary artery pressure (SPAP) >50 mmHg
Exclusion Criteria:
- Patients with non-rheumatic mitral disease
- Combined mitral and aortic valve replacement
- Mitral valve repair
- Concomitant coronary artery or aortic surgery
- Mild or organic tricuspid regurgitation
- Emergency surgery
- Reoperations
- Invalid or missed data
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
DeVega
The DeVega repair is performed when the patient had minimal annular dilation and lower severity of pulmonary hypertension
|
Tricuspid valve repair during mitral valve replacement for rheumatic heart disease using suture (DeVega) repair or ring annuloplasty
|
MC3 ring
MC3 ring annuloplasty is performed in patients with severe tricuspid annular dilation and severe pulmonary hypertension
|
Tricuspid valve repair during mitral valve replacement for rheumatic heart disease using suture (DeVega) repair or ring annuloplasty
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Residual tricuspid regirgitation (TR)
Time Frame: 3-33 months
|
residual TR is defined when there is moderate or above degree of TR at the last follow-up echocardiography of the patient
|
3-33 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Yasser A Kamal, MD, Minia University
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 62-15
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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