Aim of this prospective trial is to assess the hemodynamic effects of a MitraClip procedure caused iatrogenic arterial septal defect (iASD) and the functional changes after interventional iASD closure in a randomized setting.
Transcatheter mitral valve repair with the MitraClip system is a therapeutic alternative to surgery in selected high-risk patients. Clip placement requires interatrial transseptal puncture and meticulous manipulation of the steerable sheath. There is evidence that the persistence of a relevant iASD after MitraClip is associated with worse clinical outcomes and increased mortality. The purpose of this study is to investigate, if the interventional closure of an persistant hemodynamic relevant iASD 30 days after MitraClip implantation, has favorable effects on clinical outcome. Eligible patients, after obtaining written informed consent, are 1:1 randomized either in group A (interventional occlusion of iASD) or group B (best supportive care).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
Interventional closure of the iASD with an Figulla Flex Occluder (Occlutech)
Heart Center of the University Leipzig
Leipzig, Germany
Change in Exercise tolerance: 6 minute walking test
Time frame: baseline, 3 and 6 months
Change in New York Heart Association Functional Classification assessment
Changes in New York Heart Association Functional Classification
Time frame: baseline, 3 and 6 months
Changes in Echocardiography: bi ventricular function (2D and 3D)
Time frame: baseline, 3 and 6 months
Changes in Echocardiography: assessment of left atrium (2D and 3D)
Time frame: baseline, 3 and 6 months
Changes in Echocardiography: assessment of heart valves
Time frame: baseline, 3 and 6 months
Changes in Echocardiography: strain using speckle tracking
Time frame: baseline, 3 and 6 months
Changes in Echocardiography: evaluation of iatrogenic ASD (2D and 3D)
Time frame: baseline, 3 and 6 months
Heart insufficiency bio markers
Time frame: baseline and 6 months
Changes in Cardiac MRI: bi ventricular function
Time frame: baseline and 6 months
Changes in Cardiac MRI: left ventricular longitudinal strain
Time frame: baseline and 6 months
Changes in Cardiac MRI: left ventricular circumferential strain
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Time frame: baseline and 6 months
Changes in Cardiac MRI: flow measurements in main pulmonary artery and aorta
Time frame: baseline and 6 months
Evaluation of hospitalisation rate
Telephone
Time frame: baseline, 3, 6 and 12 months
Evaluation of mortality
Telephone
Time frame: baseline, 3, 6 and 12 months
Combined endpoint (hospitalisation and mortality)
Telephone; Combined Endpoint of hospitalisation and mortality. For analysis the first event is counted regardless of severity.
Time frame: baseline, 3, 6 and 12 months
Changes in quality of life in "Minnesota Living with Heart Failure" questionnaire
Time frame: baseline and 6 months
Changes in quality of life in "Short Form - 36" questionnaire
Time frame: baseline and 6 months