Multiple MitraClips: The Balancing Act between Pressure Gradient and Regurgitation

Abstract Objective Transcatheter mitral valve repair with the MitraClip is used for the symptomatic management of mitral regurgitation (MR). The challenge is reducing MR while avoiding an elevated mitral valve gradient (MVG). This study assesses how multiple MitraClips used to treat MR can affect valve performance. Methods Six porcine mitral valves were assessed using an in vitro left heart simulator in the native, moderate-to-severe MR, and severe MR cases. MR cases were tested in the no-MitraClip, one-MitraClip, and two-MitraClip configurations. Mitral regurgitant fraction (MRF), MVG, and effective orifice area (EOA) were quantified. Results Native MRF, MVG, and EOA were 14.22%, 2.59 mmHg, and 1.64 cm2, respectively. For moderate-to-severe MR, MRF, MVG, and EOA were 34.07%, 3.31 mmHg, and 2.22 cm2, respectively. Compared to the no-MitraClip case, one MitraClip decreased MRF to 18.57% (p Conclusions There is limited concern regarding elevation of MVG when reducing MR using one or two MitraClips, though two MitraClips did not significantly continue to reduce MRF.