Implantation of More than One MitraClip in Patients Undergoing Transcatheter Mitral Valve Repair: Friend or Foe?

Abstract

AIM: Mitral valve repair by means of cardiac surgery is effective yet associated with peri-operative complications. Transcatheter mitral valve repair (TMVR) with MitraClip is emerging as a safe and effective alternative in high-risk patients. There is uncertainty however on the outlook of patients requiring >1 MitraClip for TMVR. Methods: We retrospectively collected data on patients undergoing TMVR at three tertiary care centers. Subjects requiring a single MitraClip were compared with those requiring >1 MitraClip during the index procedure. Patients were followed after discharge for events and echocardiographic changes. Results: A total of 74 subjects were included, all but 1 achieving procedural success: 54 (74%) were treated with a single MitraClip, and 19 (26%) required >1 MitraClip. Baseline and procedural features were similar in the groups, with the notable exclusion of female gender, which was less prevalent in those requiring >1 MitraClip (p=0.030). Clinical outcomes were also similar in the groups, with a general trend toward fewer adverse events in the >1 MitraClip group. Notably, both groups showed similar improvements in MR severity during follow-up, which overall were evident in 68 cases (96%). Conclusions: Minimally invasive valve repair with MitraClip for mitral regurgitation is equally safe and effective if a single or >1 MitraClip are required. As no clear-cut features predict the need for multiple MitraClip implantation, clinicians should maintain a high index of suspicion and be prepared to perform multiple MitraClip deployments in most cases.