SMMART-HF: Effectiveness of Surgical Mitral Valve Repair Versus Medical Treatment for People With Significant Mitral Regurgitation and Non-ischemic Congestive Heart Failure

• Sponsor: Duke University (Other)
• Overall Status: Terminated
• CT.gov ID: NCT00608140
• Collaborator: National Heart, Lung, and Blood Institute (NHLBI) (NIH), Heart Failure Clinical Research Network (Other)
• Enrollment: 2
• Locations: 9
• Arms: 3
• Duration (Months): 24
• Patients Per Site: 0.2
• Patients Per Site Per Month: 0

Study Details

Study Description

Brief Summary

Mitral regurgitation (MR), also known as mitral insufficiency, is a condition in which the heart's mitral valve, located between two of the heart's main chambers, does not firmly shut, allowing blood to leak backwards within the heart. Improper functioning of the mitral valve disrupts the proper flow of blood through the body, resulting in shortness of breath and fatigue. When mild, MR may not pose a significant danger to a person's health, but severe MR may be associated with serious complications, such as heart failure, irregular heart rhythm, and high blood pressure. Although there are treatments for MR, including medication and surgery, more information is needed on the effectiveness of these treatments in people with significant MR. This study will compare the safety and effectiveness of corrective surgery added to optimal medical treatment (OMT) versus OMT alone in treating people with significant MR caused by an enlarged heart.

Condition or Disease	Intervention/Treatment	Phase
Mitral Valve Insufficiency; Heart Failure	Procedure: Surgical mitral valvuloplasty with placement of annular ring (SMVR); Drug: Optimal medical therapy (OMT)	Phase 3

Detailed Description

It is estimated that approximately 4 out of 10 people with an enlarged heart due to heart failure develop MR, referred to as secondary MR. This type of MR is caused by enlargement of the left ventricle (LV), one of the heart's main chambers. In turn, the enlargement leads to stretching of certain heart muscles around the mitral valve and of the valve itself. Symptoms of secondary MR may include shortness of breath, fatigue, dizziness, swollen feet, cough, and heart palpitations. Mitral valve repair or replacement surgery is sometimes considered as a treatment option to restore proper heart function in people with secondary MR. Surgical repair with placement of an artificial ring around the mitral valve can help to tighten the valve and add benefit to non-surgical treatments for MR. However, although surgical placement of the ring improves mitral valve function in most people, it is not known whether this surgery helps people live longer and healthier lives. This study will compare the safety and effectiveness of surgical mitral valvuloplasty with placement of an annular ring (SMVR) added to optimal medical treatment (OMT) versus OMT alone in non-ischemic heart failure patients with significant secondary MR.

Participation from baseline through follow-up in this study will last 18 months. All potential participants will initially undergo a transesophageal echocardiogram to confirm the presence of an abnormal mitral valve. Eligible participants will then undergo a number of baseline tests, which will include cardiopulmonary exercise stress testing, a chest wall echocardiogram, blood draw, 6-minute walk test, medical questionnaires, and a physical exam. Next, participants will be randomly assigned to receive immediate open heart surgery with the placement of a mitral valve ring, delayed surgery at least 18 months later, or OMT. Participants assigned to receive immediate surgery will undergo the surgery 2 weeks after baseline testing. Participants assigned to receive OMT will receive treatment with any of the following medication regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy. Follow-up visits for all participants will occur at Months 1, 3, 6, 12, and 18 and will include repeat baseline testing. Long-term survival status data may be collected beyond 18 months for some participants.

Study Design

• Study Type: Interventional
• Actual Enrollment: 2 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Surgery Versus Medical Treatment Alone for Patients With Significant Mitral Regurgitation and Non-ischemic Congestive Heart Failure: SMMART-HF
• Study Start Date: Mar 1, 2008
• Actual Primary Completion Date: Mar 1, 2010
• Actual Study Completion Date: Mar 1, 2010

Arms and Interventions

Arm	Intervention/Treatment
Experimental: 1 Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement	Procedure: Surgical mitral valvuloplasty with placement of annular ring (SMVR); Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). A complete rigid or semi-rigid annular ring will be placed unless specifically contraindicated by intraoperative findings. The ring size will be between 24 mm and 27 mm in the anteroposterior diameter. Annular ring sutures will be placed circumferentially approximately 1 mm off the hinge point between the leaflet and the atrial tissue. The total number of sutures will vary between 4 and 7 sutures anteriorly, while 8 to 12 sutures will be utilized for the posterior segment of the annulus. Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering.; Drug: Optimal medical therapy (OMT); Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.
Active Comparator: 2 Participants will receive optimal medical therapy alone	Drug: Optimal medical therapy (OMT); Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.
Experimental: 3 Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement	Procedure: Surgical mitral valvuloplasty with placement of annular ring (SMVR); Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). A complete rigid or semi-rigid annular ring will be placed unless specifically contraindicated by intraoperative findings. The ring size will be between 24 mm and 27 mm in the anteroposterior diameter. Annular ring sutures will be placed circumferentially approximately 1 mm off the hinge point between the leaflet and the atrial tissue. The total number of sutures will vary between 4 and 7 sutures anteriorly, while 8 to 12 sutures will be utilized for the posterior segment of the annulus. Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering.; Drug: Optimal medical therapy (OMT); Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.

Outcome Measures

Primary Outcome Measures

1. Effect of Adding SMVR to OMT Alone on LV Remodeling, Specifically LV End-systolic Volume Index (LVESVI) [Measured at Month 18]

Secondary Outcome Measures

1. Peak VO2 [Measured at Month 18]

2. Change in 6-minute Walk Test [Measured at baseline and Month 18 but n/a]

   The 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.

3. Change in Minnesota Living With Heart Failure (MLHF) Score [Planned to be measured at baseline and Month 18 but n/a]

   Change in MLHF score. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.

4. Total Days Alive and Total Days Not Hospitalized [Measured at baseline and Month 18]

   Total days alive and not hospitalized by 18 months. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.

5. Total Mortality (All Causes) [Measured at Month 18]

   Total all-cause mortality at 18 months. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.

6. Perioperative Mortality [Measured between Days 0 and 30 postsurgery]

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Symptomatic chronic heart failure, New York Heart Association (NYHA) class II to IIIb

• Left ventricular ejection fraction of 0.35 due to non-ischemic etiology

• Evidence by transthoracic echocardiography (TTE) of moderate or severe MR without obvious primary mitral valve pathology

• Peak VO2 less than or equal to 22 ml/kg/min, as obtained at study entry

• Optimal heart failure therapy for at least 6 months prior to study entry

Exclusion Criteria:

• Significant coronary artery disease (greater than 75% lesion in any vessel) by coronary angiography or by a history of a prior heart attack

• Heart failure due to active myocarditis, congenital heart disease, or obstructive hypertrophic cardiomyopathy

• Significant ventricular arrhythmias not treated with an implantable defibrillator

• Primary MR due to significant chordal or leaflet abnormalities by TTE

• Other hemodynamically relevant stenotic or regurgitant valvular diseases

• Severe tricuspid regurgitation (TR) (moderate TR is allowed)

• Severe pulmonic regurgitation (PR) (moderate PR is allowed)

• Moderate to severe aortic regurgitation

• Any moderate to severe stenotic lesions using American Heart Association/American College of Cardiology (AHA/ACC) criteria 31

• Dependence on chronic inotropic therapy

• Restrictive cardiomyopathy or constrictive pericarditis

• Severe right ventricular dysfunction

• Baseline creatinine greater than or equal to 3 mg/dL or renal replacement therapy (chronic hemodialysis or peritoneal dialysis)

• Poor transthoracic sonographic windows precluding reasonable assessment of LV endocardial borders from apical imaging on TTE

• Inability to perform the spirometric exercise testing

• Significant chronic lung disease that might interfere with the ability to interpret the spirometric measurements, including home oxygen, forced expiratory volume in 1 second (FEV1) less than 1.0 L/min, or exertional hypoxemia with saturations less than 90%

• Any known neoplastic disease other than skin cancer

• Other terminal illness with a life expectancy less than 1 year

• Plan for percutaneous mitral valve procedure

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Morehouse School of Medicine	Atlanta	Georgia	United States	30310
2	Brigham and Women's Hospital	Boston	Massachusetts	United States	02115
3	Minnesota Heart Failure Network	Minneapolis	Minnesota	United States	55415
4	Mayo Clinic	Rochester	Minnesota	United States	55905
5	Duke University Medical Center	Durham	North Carolina	United States	27705
6	Baylor College of Medicine	Houston	Texas	United States	77030
7	University of Utah Health Sciences Center	Murray	Utah	United States	84107
8	University of Vermont - Fletcher Allen Health Care	Burlington	Vermont	United States	05401
9	Montreal Heart Institute	Montreal	Quebec	Canada	H1T - 1C8

Sponsors and Collaborators

• Duke University
• National Heart, Lung, and Blood Institute (NHLBI)
• Heart Failure Clinical Research Network

Investigators

• Principal Investigator: Kerry L. Lee, PhD, Duke Clinical Research Institute
• Study Chair: Eugene Braunwald, MD, Harvard University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Duke University
• ClinicalTrials.gov Identifier: NCT00608140
• Other Study ID Numbers: Pro00002860; U01HL084904
• First Posted: Feb 6, 2008
• Last Update Posted: Apr 4, 2018
• Last Verified: Jul 1, 2013

• Keywords provided by Duke University: Advanced Heart Failure; Non-Ischemic Heart Failure; Mitral Regurgitation; Mitral Valve Replacement; Congestive Heart Failure; Surgical Mitral Valvuloplasty; Dilated Cardiomyopathy; Annular Ring
• Additional relevant MeSH terms: Heart Failure; Mitral Valve Insufficiency

Study Results

Participant Flow

Arm/Group Title	1 Medical Therapy Plus Surgery	2 Medical Therapy Only
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement	Participants will receive optimal medical therapy alone
Period Title: Overall Study
STARTED	1	1
COMPLETED	0	0
NOT COMPLETED	1	1

Baseline Characteristics

Arm/Group Title	1 Medical Therapy Plus Surgical Repair	2 Medical Therapy Only	Total
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement	Participants will receive optimal medical therapy alone	Total of all reporting groups
Overall Participants	1	1	2
Age (Count of Participants)
<=18 years	0 0%	0 0%	0 0%
Between 18 and 65 years	0 0%	1 100%	1 50%
>=65 years	1 100%	0 0%	1 50%
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	65.5	63	64.25 (1.49)
Sex: Female, Male (Count of Participants)
Female	0 0%	1 100%	1 50%
Male	1 100%	0 0%	1 50%
Region of Enrollment (participants) [Number]
United States	1 100%	1 100%	2 100%

Outcome Measures

1. Primary Outcome

Title	Effect of Adding SMVR to OMT Alone on LV Remodeling, Specifically LV End-systolic Volume Index (LVESVI)
Time Frame	Measured at Month 18

Outcome Measure Data

Analysis Population Description

Data were not analyzed due to study termination

Arm/Group Title	1 Medical Therapy Plus Surgery	2 Medical Therapy Only
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement	Participants will receive optimal medical therapy alone
Measure Participants	0	0

2. Secondary Outcome

Title	Peak VO2
Time Frame	Measured at Month 18

Outcome Measure Data

Analysis Population Description

The 2 patients enrolled in the study did not reach their endpoints before the trial was closed. No data were collected for this outcome measure and no analysis was performed.

Arm/Group Title	Optimal Medical Therapy Plus Surgical MV Repair	Optimal Medical Therapy Alone	Optimal Medical Therapy Plus 18 Month Delayed MVR
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). A complete rigid or semi-rigid annular ring will be placed unless specifically contraindicated by intraoperative findings. Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering.	Participants will receive optimal medical therapy alone Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering.
Measure Participants	0	0	0

3. Secondary Outcome

Title	Change in 6-minute Walk Test
Description	The 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.
Time Frame	Measured at baseline and Month 18 but n/a

Outcome Measure Data

Analysis Population Description

The 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.

Arm/Group Title	Optimal Medical Therapy Plus Surgical MVR	Optimal Medical Therapy Alone	Optimal Medical Therapy Plus 18 Month Delayed MVR
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or signific	Participants will receive optimal medical therapy alone Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for rup
Measure Participants	0	0	0

4. Secondary Outcome

Title	Change in Minnesota Living With Heart Failure (MLHF) Score
Description	Change in MLHF score. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.
Time Frame	Planned to be measured at baseline and Month 18 but n/a

Outcome Measure Data

Analysis Population Description

the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.

Arm/Group Title	Optimal Medical Therapy Plus Surgical MVR	Optimal Medical Therapy Alone	Optimal Medical Therapy Plus 18 Month Delayed MVR
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy alone Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.
Measure Participants	0	0	0

5. Secondary Outcome

Title	Total Days Alive and Total Days Not Hospitalized
Description	Total days alive and not hospitalized by 18 months. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.
Time Frame	Measured at baseline and Month 18

Outcome Measure Data

Analysis Population Description

The 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.

Arm/Group Title	Optimal Medical Therapy Plus Surgical MVR	Optimal Medical Therapy Alone	Optimal Medical Therapy Plus 18 Month Delayed MVR
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy alone Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.
Measure Participants	0	0	0

6. Secondary Outcome

Title	Total Mortality (All Causes)
Description	Total all-cause mortality at 18 months. However, the 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No analysis was performed.
Time Frame	Measured at Month 18

Outcome Measure Data

Analysis Population Description

The 2 patients enrolled did not meet the 18 month measurement of primary/secondary endpoints before the trial was terminated. No data were collected for this outcome measure and no analysis was performed.

Arm/Group Title	Optimal Medical Therapy Plus Surgical MVR	Optimal Medical Therapy Alone	Optimal Medical Therapy Plus 18 Month Delayed MVR
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). A complete rigid or semi-rigid annular ring will be placed unless specifically contraindicated by intraoperative findings. Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy alone Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.	Participants will receive optimal medical therapy plus 18-month delayed surgical mitral valve repair with complete annular ring placement Surgical mitral valvuloplasty with placement of annular ring (SMVR): Participants will undergo open heart surgery to mechanically reduce mitral regurgitation (MR). A complete rigid or semi-rigid annular ring will be placed unless specifically contraindicated by intraoperative findings. Additional repair of the mitral apparatus itself will be based on intraoperative findings. Leaflet repair will be performed for significant prolapse. Submitral apparatus repair will be performed for ruptured or significantly elongated chordae as well as significant chordal tethering. Optimal medical therapy (OMT): Optimal medical therapy can include, but is not limited to, any of the following treatment regimens: combination of vasodilator therapy and diuretics, nitrates and nifedipine, and beta-adrenergic blocker therapy.
Measure Participants	0	0	0

7. Secondary Outcome

Title	Perioperative Mortality
Time Frame	Measured between Days 0 and 30 postsurgery

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	1 Medical Therapy Plus Surgery	2 Medical Therapy Only
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement	Participants will receive optimal medical therapy alone
Measure Participants	1	1
Number [participants]	0 0%	0 0%

Adverse Events

Adverse Event Reporting Description	Adverse events were not collected, only serious adverse events were collected. "0" was entered for Total Number of Participants at Risk where Adverse events were not collected.
Arm/Group Title	1 Medical Therapy Plus Surgery		2 Medical Therapy Only
Arm/Group Description	Participants will receive optimal medical therapy plus surgical mitral valve repair with complete annular ring placement		Participants will receive optimal medical therapy alone
All Cause Mortality
	1 Medical Therapy Plus Surgery		2 Medical Therapy Only
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	1 Medical Therapy Plus Surgery		2 Medical Therapy Only
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	1/1 (100%)		1/1 (100%)
Cardiac disorders
CARDIAC FAILURE	0/1 (0%)	0	1/1 (100%)	1
HAEMODYNAMIC INSTABILITY	0/1 (0%)	0	1/1 (100%)	1
ATRIAL FIBRILLATION	1/1 (100%)	1	0/1 (0%)	0
Other (Not Including Serious) Adverse Events
	1 Medical Therapy Plus Surgery		2 Medical Therapy Only
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.