Outcome of Preserved Mitral Valve Apparatus During Mitral Valve Replacement (EarlyOutcome)
Outcome of Preservation of Mitral Valve Leaflets During Mitral Replacement
Are there differences in outcome of mitral valve replacement with preservation of mitral apparatus among rheumatic and/or ischemic mitral lesions?.
Mitral valve replacement with preservation of leaflets, and added coronary artery-bypass surgery, when indicated, is it a feasible and reproducible procedure?.
The study was designed to compare outcome after prosthetic mitral replacement with preservation of mitral apparatus for rheumatic valve disease with outcome of replacement for ischemic myocardium and mitral valve disease, The outcomes will be guided by clinical assessment. and echo-cardiograph.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Yksityiskohtainen kuvaus
Objectives: The aim is to compare outcome of modified preservation of mitral valve apparatus during prosthetic mitral replacement for rheumatic versus myocardial ischemia &mitral valve disease.
Methods ;This prospective cross-sectional comparative study will include 50 patients with isolated rheumatic mitral valve disease (group A) and 50 patients with mitral disease and myocardial ischemia (group B), surgery is expected to be performed between 2017 and 2020 at one center. All patients will have modified preservation of mitral apparatus during prosthetic mitral replacement. Additionally, group B patients will have bypass grafts to left anterior descending and/or posterior descending / right coronary artery. Data will be collected and analyzed.
The Institutional Review Board (IRB), Ethics Committee (EC)-approval and consent of each patient were obtained.
Criteria for inclusion of patients and exclusion of others were determined according to the guide lines.
Statistical analysis::
Qualitative variables and their association among both groups were studied by applying Chi-square test and Fisher Exact test. Quantitative variables among both groups were compared by applying independent samples t-test. P < 0.05 values mean statistically-significant results.
Opintotyyppi
Ilmoittautuminen (Todellinen)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
-
-
-
Ismailia, Egypti, +064
- Suez Canal University
-
Ismailia, Egypti, 002-064
- Suez Canal University
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria::
Mitral stenosis (MS)
- symptoms are severely limiting and cannot be managed with diuresis and heart rate control.
Mitral regurgitation(MR):
* acute severe MR require surgical correction for hemo-dynamics and relief of symptoms .
Chronic primary mitral regurgitation:
* rheumatic heart disease: replacement before irreversible changes occur can be curative.
Mixed Mitral Stenosis and Mitral Regurgitation:
- If beta blockers and diuretics do not relieve symptoms, replacement should be performed only in patients who have severe limiting symptoms.
- Myocardial ischemia associating or complicated with miral valve disease.
Exclusion criteria
- Patients showing good response to medical therapy, and Cases complicated by:
- ineffective endocarditis,
- previous myocardial re-vascularization
- ischemic ventricular septal defect,
- left ventricular aneurysm,
- Ruptured papillary muscles of mitral apparatus.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Huijausvertailija: Group A
50 patients with isolated rheumatic mitral valve disease (group A)
|
St.Jude prosthetic(FDA approved) mitral valve replacement with or without coronary artery bypass grafts
Muut nimet:
|
|
Muut: Group B
50 patients with mitral disease and myocardial ischemia (group B)
|
St.Jude prosthetic(FDA approved) mitral valve replacement with or without coronary artery bypass grafts
Muut nimet:
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Smoking index
Aikaikkuna: One week before surgery(or during first clinical visit) .
|
Number of Packs every day X number of years of smoking= Pack.year,
|
One week before surgery(or during first clinical visit) .
|
|
Age and gender for each participant
Aikaikkuna: One week before surgery .
|
Males above 40 years and Females above 45 years need pre-operative coronary angio-graph
|
One week before surgery .
|
|
For each participant: pathological:type of mitral valve lesion
Aikaikkuna: Seven days before surgery .
|
severe stenosis with mitral area < 1 cm square, severe regurgitation, or mixed lesions
|
Seven days before surgery .
|
|
For each participant: etiological :type of mitral valve lesion
Aikaikkuna: Seven days before surgery .
|
Rheumatic: distorted thickened leaflets,thickened fibrosed chordae
|
Seven days before surgery .
|
|
For each participant: etiological :type of mitral valve lesion
Aikaikkuna: Seven days before surgery- echo-cardiograph.
|
Rheumatic: distorted thickened leaflets,thickened fibrosed chordae or ischemic incompetence
|
Seven days before surgery- echo-cardiograph.
|
|
For each participant:, assessing sub-valvular apparatus
Aikaikkuna: One week before surgery. with Echo-cardiograph.
|
Thickened chordae, ruptured chordae, ischemia of papillary muscles or lateral ventricular wall.
|
One week before surgery. with Echo-cardiograph.
|
|
Abascal echo-cardiographic mitral valve score (Wilkins score)
Aikaikkuna: One week before surgery.with Echo-cardiograph
|
:if score is 8 or less it is good for balloon valvo-plasty, if > 8 surgery is recommended ( leaflet mobility, thickness and calcification.
Fourthly, sub-valvular thickening., higher scores = more deterioration
|
One week before surgery.with Echo-cardiograph
|
|
left ventricular wall motion abnormality
Aikaikkuna: one week before surgery - with an echo-cardiograph
|
hypokinesia, Akinesia, Dyskinesia of certain segment(s)
|
one week before surgery - with an echo-cardiograph
|
|
Number of participants with Signs of left ventricular dysfunction
Aikaikkuna: seven days before surgery echo-cardiograph examination
|
low ejection fraction <52%, low stroke volume< 70 ml, low cardiac output <5 litres per minute
|
seven days before surgery echo-cardiograph examination
|
|
Number of participants with pre-operative coronary artery disease
Aikaikkuna: seven days before surgery, coronary angio-graph
|
Expected on clinical bases and .proved
by Echo-cardiograph-findings
|
seven days before surgery, coronary angio-graph
|
|
Number of participants with pre-operative ischemic complications
Aikaikkuna: seven days before surgery echo-cardiograph examination
|
left ventricular thrombi, septal and left ventricular wall thickness in mm .
|
seven days before surgery echo-cardiograph examination
|
|
Assessment of any evolving new prosthetic valve dysfunction
Aikaikkuna: intra-operative trans-esophageal echo-cardiograph examination
|
Left atrioventricular outflow stenosis, prosthetic dysfunction due to preservation of valve apparatus
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intra-operative trans-esophageal echo-cardiograph examination
|
|
Change in post-operative left ventricular functions
Aikaikkuna: 5 days post-operatively and end of 6th and 12 months after surgery with Echo-Cardiograph
|
: Low Fractional Shortening < 28% , Ejection fraction < 40%,, increased left ventricular dimensions and volume
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5 days post-operatively and end of 6th and 12 months after surgery with Echo-Cardiograph
|
|
Change of Prosthetic mitral valve functions
Aikaikkuna: Monthly through study completion up to 12 months after surgery..... with Echo-cardiograph
|
Development of para-valvular leak or central jet of regurgitation or stuck valve by a thrombus
|
Monthly through study completion up to 12 months after surgery..... with Echo-cardiograph
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
changes on Clinical examination
Aikaikkuna: Monthly up to 12 months after surgery)
|
local and general Examination,: a new murmur, evolving heart failure
|
Monthly up to 12 months after surgery)
|
|
Changes in Results of Prothrombin time, concentration and.International normalized ratio
Aikaikkuna: .Monthly through study completion up to 12 months.
|
Adjust dose of oral anticoagulant.( between double and half to three times the control) Dose usually ranges between 1 and 11 mg warfarin tablet daily.
|
.Monthly through study completion up to 12 months.
|
|
Mortality and Morbidity
Aikaikkuna: Monthly through study completion up to 12 months.
|
cause of mortality, type of morbidity: wound infection, hypertrophied scar, Kiloid Formation
|
Monthly through study completion up to 12 months.
|
Yhteistyökumppanit ja tutkijat
Sponsori
Yhteistyökumppanit
Tutkijat
- Opintojohtaja: Mohamed A. allaban, PhD, Suez Canal University, FOM- Research Ethics Committee
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Todellinen)
Opintojen valmistuminen (Todellinen)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
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