The Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2
The Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2
Multicentre, double-armed, randomized controlled trial designed to compare mitral valve
 leaflet resection versus leaflet preservation with regards to the development of functional
 mitral stenosis following surgical repair of mitral valve prolapse. Patients will be
 randomized (1:1) to receive: (1) mitral valve repair with a leaflet resection or (2) mitral
 valve repair with leaflet preservation (using polytetrafluoroethylene neochordae), followed
 by echocardiographic and clinical assessment at 12-months following surgery.
Mitral valve repair has emerged as the preferred surgical treatment for mitral valve prolapse
 (MVP), a condition wherein the mitral valve does not close properly. One common strategy for
 mitral valve repair is leaflet resection, which involves removing part of one or both of the
 mitral leaflets that flop or bulge back (prolapse). Another strategy is leaflet preservation,
 which involves placing man-made fibers (sutures) to more securely connect the mitral leaflets
 to the papillary muscles (muscles located in the ventricle). While both strategies are
 routinely used and lead to successful mitral valve repair, there is no clear evidence as to
 whether one strategy is better than the other in terms of long term outcome. The purpose of
 this study is to determine if one repair strategy (leaflet resection versus leaflet
 preservation) leads to better longer term patient outcomes. A total of 88 patients from 6
 Canadian centres will be randomly assigned to one of the two strategies. The primary outcome
 will be functional mitral stenosis (MS) as assessed by 12-month mean mitral valve pressure
 gradient at peak exercise.
Inclusion Criteria:

 1. Patients with mitral regurgitation and mitral valve prolapse who are scheduled for
 elective mitral valve repair by an experienced mitral valve repair surgeon (>15
 degenerative mitral valve repairs per year, with a repair rate>90%, and able to
 perform mitral repair with either a leaflet resection or leaflet preservation
 strategy).

 2. Planned mitral valve repair amenable to either a leaflet resection or leaflet
 preservation surgical repair strategy

 Exclusion Criteria:

 1. Patients with anterior leaflet or commissural prolapse

 2. Patients with endocarditis or rheumatic mitral valve disease

 3. Patients with mitral annular calcification extending beyond the circumference of one
 leaflet scallop

 4. Patients with significant LV dysfunction defined as a LVEF <40%

 5. Patients undergoing concomitant aortic valve surgery

 6. Patients unable to undergo bicycle ergometry