G4 MitraClip System for Mitral Regurgitation

Quick Takes

  • This real-world study of primary and secondary MR patients reported that the use of G4 MitraClip was associated with an excellent reduction in MR at 30 days.
  • The two factors that primarily contributed to the greater reduction in MR with the G4 MitraClip were the availability of wide clip and the ability to raise and lower the grippers independently.
  • The results of this small retrospective study need to be confirmed in larger prospective multicenter studies with independent echo core lab assessment.

Study Questions:

What is the effectiveness of the next-generation G4 MitraClip System in the reduction of mitral regurgitation (MR)?

Methods:

The investigators included consecutive patients undergoing transcatheter mitral edge-to-edge repair for MR with the G4 MitraClip. The key outcome was the proportion of patients with MR reduction to ≤2+ at 30 days. Additional outcome measures included procedural and 30-day outcomes, echocardiographic assessment, and distribution of G4 MitraClip use for the overall patient population as well as separately for patients with primary or secondary MR. Continuous variables were presented as median (interquartile range [IQR]) and compared using independent sample Mann-Whitney U Test.

Results:

Fifty-nine patients (median age 77 years, 62.7% male) were treated with G4 MitraClip. Reduction of MR to ≤2+ was achieved in 57 of 59 patients (96.6%) during the procedure, 58 of 59 patients (98.3%) at discharge, and 57 of 59 patients (96.5%) by 30 days. The median number of MitraClips used per patient was 2 (IQR 1-3). The wide clip (NTW/XTW) was used in 82.7% of the cases. The XTW clip was used most frequently as the first clip in patients with degenerative MR (65.4%) and NTW in secondary MR (72.7%). The independent grasping mechanism was used in 49.2% of the patients.

Conclusions:

The authors concluded that the use of G4 MitraClip system was associated with excellent reduction in MR to ≤2+ in 96.5% of the patients at 30 days.

Perspective:

This real-world study of primary and secondary MR patients reported that the use of G4 MitraClip was associated with an excellent reduction in MR at 30 days. The two factors that primarily contributed to the greater reduction in MR with the G4 MitraClip were the availability of wide clip and the ability to raise and lower the grippers independently. It seems that the newer MitraClip G4 System may facilitate further optimization of transcatheter edge-to-edge repair for the treatment of MR. Finally, the results of this small retrospective study need to be confirmed in larger prospective multicenter studies with independent echo core lab assessment.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Cardiac Surgical Procedures, Echocardiography, Geriatrics, Heart Valve Diseases, Mitral Valve Insufficiency, Outcome Assessment (Health Care), Patient Discharge, Secondary Prevention, Transcatheter Aortic Valve Replacement


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