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Observational Study
. 2025 Sep 2;14(17):e041907.
doi: 10.1161/JAHA.125.041907. Epub 2025 Aug 29.

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

Shunsuke Kubo  1 , Masanori Yamamoto  2   3   4 , Mike Saji  5   6 , Masahiko Asami  7 , Yusuke Enta  8 , Shinichi Shirai  9 , Masaki Izumo  10 , Shingo Mizuno  11 , Yusuke Watanabe  12 , Yuki Izumi  5 , Makoto Amaki  13 , Kazuhisa Kodama  14 , Junichi Yamaguchi  15 , Daisuke Hachinohe  16 , Toru Naganuma  17 , Hiroki Bota  18 , Yohei Ohno  19 , Masahiro Yamawaki  20 , Hiroshi Ueno  21 , Gaku Nakazawa  22 , Toshiaki Otsuka  23 , Kentaro Hayashida  24 ; OCEAN‐Mitral investigators
Collaborators, Affiliations
Observational Study

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

Shunsuke Kubo et al. J Am Heart Assoc. .

Abstract

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, P=0.04) and a higher proportion of the MR severity ≤1+ at 1 year (68.2% versus 48.6%, P=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.

Keywords: MitraClip G4; clip selection; edge‐to‐edge repair; mitral regurgitation; structural heart disease.

PubMed Disclaimer

Conflict of interest statement

Clinical proctors of TEER for Abbott Medical: Drs Kubo, Saji, Yamamoto, Asami, Enta, Shirai, Izumo, Mizuno, Watanabe, Izumi, Amaki, Yamaguchi, Bota, Ohno, Ueno, Mizutani, and Hayashida. Lecturer fees from Abbott Medical: Drs Kubo, Saji, Yamamoto, Asami, Enta, Shirai, Izumo, Mizuno, Watanabe, Amaki, Kodama, Yamaguchi, Bota, and Ohno. Consultant fees from Abbott Medical: Drs Kubo, Saji, Yamamoto, Enta, Izumo, Shirai, Mizuno, Watanabe, Amaki, Bota, and Ohno. Scholarship donation from Abbott Medical: Dr Yamaguchi. Advisor of Abbott Medical: Dr Ohno.

Figures

Figure 1
Figure 1. Initial clip types.
The most used clip type was NTW followed by XTW, NT, and XT. NT and NTW were considered narrow clips, XT and XTW were considered long clips, NT and XT were considered narrow clips, and NTW and XTW were considered wide clips.
Figure 2
Figure 2. MR severity and MVPG at discharge based on the initial clip type.
Residual MR severity according to the initial clip type (left panel). MR severity, degree of MR reduction, and MVPG in patients receiving the initial long vs short clip strategy (right upper panel) and those the initial wide vs narrow clip strategy (right lower panel). MR indicates mitral regurgitation; and MVPG, mitral valve mean pressure gradient.
Figure 3
Figure 3. Incidence of death or heart failure hospitalization according to the initial clip type.
Cumulative incidence of death or heart failure hospitalization in patients receiving the initial long vs short clip strategy (left panel) and receiving the initial wide vs narrow clip strategy (right panel).
Figure 4
Figure 4. MR severity of propensity‐matched population with primary and secondary MR.
A, MR severity of patients receiving the initial long vs short clip strategy (left panel) and that of patients receiving the initial wide vs narrow clip strategy (right panel) in the propensity‐matched population with primary MR. B, MR severity of patients receiving the initial long vs short clip strategy (left panel) and that of patients receiving the initial wide vs narrow clip strategy (right panel) in the propensity‐matched population with secondary MR. MR indicates mitral regurgitation.
See this image and copyright information in PMC

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