Surgery in Secondary Tricuspid Regurgitation
- Conditions
- Tricuspid Regurgitation
- Interventions
- Procedure: Tricuspid valve repair
- Registration Number
- NCT03953755
- Lead Sponsor
- Saint Petersburg State University, Russia
- Brief Summary
Currently, in cardiology/cardiosurgery the indicators for the surgical correction of secondary tricuspid regurgitationare unclear. AIM: To compare right ventricle structural and functional changes after operation in patients with secondary tricuspid regurgitation with severe mitral /aortic valve pathology, requiring surgical intervention; define the factors influencing major adverse cardiac events depending on the operation/non-operation due to moderate tricuspid regurgitation. This study intends to include 200-300 people and will occur over 5 years with an additional 3-year follow-up.
- Detailed Description
Background It has been demonstrated in recent large patient monitoring registers that the presence of even mild secondary tricuspid regurgitation (TR) has a significant effect on life expectancy. Currently, in cardiology/cardiosurgery the indicators for the surgical correction of secondary TR are unclear. In this area, international guidelines lack randomized studies and are based on a C level of evidence. C level evidence is based solely on the opinion of experts, retrospective, and/or observational studies. The first indicator for tricuspid valve (TV) surgery is considered to be a combination of TR with severe aortic or mitral valve lesions that require surgical treatment. However, the level of indicators for moderate corrections in such situations is typically II A-B. At the C level of evidence there is no consensus for surgical treatment of such a defect in the international community. Severe TR indicators are Class I while the evidence remains C level because it is not well established that surgical treatment improves the prognosis of these patients. There is a lack of information about the structural and functional changes of the right ventricle after surgery depending on the degree of TR.
Aims and objectives of studying AIM: To compare right ventricle structural and functional changes after operation in patients with secondary tricuspid regurgitation with severe mitral /aortic valve pathology, requiring surgical intervention; define the factors influencing major adverse cardiac events depending on the operation/non-operation due to moderate tricuspid regurgitation.
OBJECTIVES:
1. To study tricuspid regurgitation parameters affecting the long-term prognosis for the surgical correction of severe secondary tricuspid regurgitationof patients with severe aortic/mitral valve pathology requiring surgical treatment.
2. To define hemodynamic parameters of patients with moderate tricuspid regurgitation, when surgical treatment of this defect gives an additional improvement in the short-term and long-term prognosis following surgical treatment of severe aortic/mitral valve diseases.
3. To study changes in contractility parameters in the right ventricle and tricuspid valve function after reconstructive surgery over a period of 3 years.
Methods and study plans This study intends to include 200-300 people and will occur over 5 years with an additional 3-year follow-up.
Inclusion criterion: 1) Signed informed consent form, 2) Previously diagnosed aortic or mitral heart diseases requiring surgical treatment, 3) Over 18 years of age 4) The presence of moderate or severe secondary tricuspid insufficiency.
Exclusion criterion: 1) Significant oncology diseases with a known prognosis of a less than 1 year life expectancy.
Cardiologist examination and survey. Echocardiography All patients will undergo standard echocardiography, including a detailed study of the function and sizes of the right ventricle and right atrium, and measurement of global longitudinal left ventricular deformations using the Speckle Tracking method, peak systolic and diastolic blood flow velocity in TV, fractional changes in area, and tricuspid annulus systolic excursion. Tricuspid regurgitation will be measured according to the standards of EAE/ASE, and will also use the recent 3-tiered classification system of severe insufficiency.
Laboratory techniques Standard for surgical treatment of aortic/mitral valve Coronary catheterization Standard for surgical treatment of aortic/mitral valve, Plan I. Initial visit - cardiologist/cardiosurgeon clinical evaluation - survey and examination II. Echocardiography study - screening - defining degree of tricuspid regurgitation III. Common tests for surgical treatment of aortic/mitral valve IV. Patient randomization with only a moderate degree of TR V. Surgical treatment VI. 30-40 days after surgery - cardiologist examination VII. 90 days after surgery ¬ - cardiologist examination + echocardiography VIII. 1 year after surgery - cardiologist examination + echocardiography IX. 3 years after surgery - cardiologist examination + echocardiography Expected benefits for patients All patients will receive advanced tests using the latest safe ultrasound methods. Frequent echocardiography and patient observations can reveal possible complications after cardiac surgery for aortic/mitral diseases; This study will allow for the correction of drug therapy due to extended diagnosis.
Severe lesions of the tricuspid valve and aortic / mitral heart defects will be corrected in all patients.
New and / or untested methods of treatment will not be used in this study. All surgical procedures will already have undergone testing and been proven effective for the treatment of heart diseases.
Recruitment & Eligibility
- Status
- SUSPENDED
- Sex
- All
- Target Recruitment
- 150
- Age > 18 years
- Indication left-side valve surgery
- Unwillingness to give informed consent and to enter a regular follow-up program.
- Prior surgical or percutaneous mitral valve intervention
- Contraindication to cardiopulmonary bypass (CPB)
- Clinical signs of cardiogenic shock at the time of randomization
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description moderate TR - left-side surgery+TVS Tricuspid valve repair moderate tricuspid regurgitation - left-side surgery+tricuspid valve surgery
- Primary Outcome Measures
Name Time Method Difference in tricuspid annular plane systolic excursion 3 month, 1 year, 3 year Difference in TAPSE between of pre- and post- operation
Difference in fraction of area contraction of right ventricle 3 month, 1 year, 3 year Difference in fraction of area contraction between pre- and post- operation
Difference in right ventricle global strain rate 3 month, 1 year, 3 year Difference in right ventricle global strain rate between of pre- and post- operation
tricuspid regurgitant volume 3 month, 1 year, 3 year tricuspid regurgitant volume
Difference in right atrium volume index 3 month, 1 year, 3 year Difference in right atrium volume index between of pre- and post- operation
Difference in end-diastolic dimension 3 month, 1 year, 3 year Difference in end-diastolic dimension of right ventricle between of pre- and post- operation
vtricuspid effective regurgitant oriface 3 month, 1 year, 3 year tricuspid effective regurgitant oriface
square of tricuspid regurgitation 3 month, 1 year, 3 year square of tricuspid regurgitation
- Secondary Outcome Measures
Name Time Method major adverse cardiac events 3 month, 1 year, 3 year death, myocardial infarction, new hospital readmission, heart transplant, ventricular assist device implantation, aborted sudden death, pulmonary oedema
rate of all-cause death 3 month, 1 year, 3 year all-cause death
Trial Locations
- Locations (1)
St. Petersburg State University
🇷🇺Saint Petersburg, Russian Federation