Real-World Outcomes of the Initial Clip Selection for Transcatheter Edge-to-Edge Repair Using the MitraClip G4 From the Optimized Catheter Valvular Intervention-Mitral Registry.

Background: The association of outcomes with initial clip selection has not been investigated in patients undergoing transcatheter edge-to-edge repair with the MitraClip G4.

Methods: We analyzed 2257 patients receiving the MitraClip G4 according to the initial clip type: short (NT/NTW) versus long (XT/XTW) and narrow (NT/XT) versus wide (NTW/XTW). We performed a propensity-matched analysis of baseline anatomical features in patients with primary and secondary mitral regurgitation (MR).

Results: The proportions of the initial clip types were as follows: NT, 18.9%; NTW, 41.7%; XT, 5.1%; and XTW, 34.3%. The proportions of the MR severity ≤1+ at discharge and 1 year were not significantly different among the 4 clip types. The incidence of death or heart failure hospitalization was not significantly different between the initial long and short clip groups and between the initial wide and narrow clip groups. After propensity matching, in patients with primary MR, long clips were significantly associated with a greater MR reduction (2.87±0.89 versus 2.62±0.99, =0.04) and a higher proportion of the MR severity ≤1+ at 1 year (68.2% versus 48.6%, =0.04) than short clips. In patients with secondary MR, long or wide clips had a similar MR severity at discharge and 1 year as short or narrow clips.

Conclusions: Residual MR severity and outcomes were not different regardless of the initial clip type, indicating the optimal clip selection in the real-world settings with the MitraClip G4. In patients with primary MR, greater and more durable MR reduction may be expected by using the initial long clips.

Registration: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN-ID: UMIN000023653.