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Surgical Mitral Repair or Mitral Clip for Degenerative Mitral Valve Regurgitation?

We are enrolling in this NIH sponsored trial investigating surgical mitral valve repair versus mitral clip in patients 65 years old or older, of any risk status.  Patients suitable for surgery or clip are randomized to the procedure, and will be followed for 10 years.

From Clinical Trials.gov:  https://clinicaltrials.gov/ct2/show/NCT05051033

This is a prospective, multicenter, open-label, randomized trial comparing mitral valve (MV) transcatheter edge-to-edge repair (TEER) to surgical repair (1:1 ratio) in patients with primary, degenerative mitral regurgitation (MR). The trial will be conducted in the U.S., Canada, Germany and the United Kingdom, and is designed as a strategy trial. Thus, all devices legally marketed for TEER of primary degenerative MR in a particular country are eligible to be used in this trial.

The primary aim of this study is to evaluate the long-term effectiveness and safety of MV TEER compared with surgical repair in patients with primary, degenerative MR. The secondary aim is to analyze the relationship between the adequacy of MR correction at one-year post randomization and longer-term clinical outcomes (death, heart failure hospitalizations/urgent care visits, valve re-interventions, and quality of life). The tertiary aim of this trial is to evaluate a range of patient-centered outcomes (quality of life, functional status, and discharge location) of transcatheter edge-to-edge MV repair compared with MV surgical repair in patients with primary, degenerative mitral regurgitation.

The patient population for this trial consists of adult patients with severe, primary degenerative MR for whom the local heart team has verified that an indication for MV intervention is present and for whom both transcatheter edge-to-edge and surgical repair strategies are anatomically feasible.

Because the use of the commercial edge-to-edge mitral repair device in the U.S. is approved only in patients considered to be at prohibitive risk of MV surgery by a heart team, use of such devices in this trial is considered investigational by the FDA. As such, this trial will be conducted under an Investigational Device Exemption (IDE ).

All patients with qualifying MR, who decline randomization, will be offered the option of enrollment in a parallel registry that captures their baseline risk profile and their treatment strategy received. These patients will also be asked to fill out a brief decliner survey.

Outcomes will be measured over a period of 5 years. The estimated enrollment period is 36 months, and all patients will be followed for up to 10 years post randomization for particular endpoints. Long-term follow-up will include leveraging administrative datasets linked to clinical trial data.

 

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