In patients with significant residual MR after the first clip, multiple-clip implantation improved MR reduction and 1-year outcomes without increasing complications, and even in moderate residual MR, additional clips were associated with more favorable clinical outcomes.
Among 826 patients with moderate or greater residual MR after the first clip during transcatheter edge-to-edge repair, most received additional clips.
Procedural technical success and complication rates were comparable between the single-clip and multiple-clip groups.
Multiple-clip implantation produced greater MR reduction and higher transmitral pressure gradients than single-clip implantation.
The composite of all-cause mortality and heart failure hospitalization at 1 year was less frequent in the multiple-clip group.
Multiple-clip implantation was associated with greater and more sustained improvement in New York Heart Association functional class.
The benefit of multiple clips on major adverse cardiovascular events was consistent across residual MR severity subgroups, including moderate residual MR.
This study looked at patients who had a catheter-based mitral valve repair (transcatheter edge-to-edge repair, which places a clip on the leaky mitral valve). In 826 patients, the valve was still leaking at a moderate or worse level after the first clip. Of these, 713 had additional clips placed and 113 had only the single clip. The study was a retrospective review of records at one medical center from 2014 to 2023. The researchers found that patients who received more than one clip had a greater reduction in leakage, though they also had higher pressure gradients across the valve. Procedural success and complication rates were similar between groups. At 1 year, 16.8% of the multiple-clip patients had died or been hospitalized for heart failure, compared with 29.2% of the single-clip patients. Multiple-clip patients also had greater and more lasting improvement in heart failure symptoms. The pattern held even when the leakage after the first clip was only moderate. This research suggests that adding clips when significant leakage remains after the first clip may be associated with better 1-year outcomes without more complications. However, because the study was retrospective and not a randomized trial, it shows an association rather than proving that extra clips caused the better results. Other differences between patients could also explain some of the findings.
Nagasaka T, Patel V, Suruga K, Shitan H, Guo Y, Koren O, et al.. (2026). Clinical Impact of Multiple-Clip Implantation for Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.050013