Comparison of Outcomes of Transcatheter Edge-to-Edge Repair With Early Versus Latest Generation MitraClip for Severe Mitral Regurgitation.

Background: The fourth-generation MitraClip G4 system is the latest version of the transcatheter edge-to-edge repair (TEER) system for mitral regurgitation (MR).

Aim: This study aimed to evaluate the effectiveness of the MitraClip G4 in the reduction of MR compared to the early-generation MitraClip.

Method: We performed a retrospective analysis of consecutive patients undergoing TEER for MR with either the early-generation or newer-generation MitraClip G4 from a single-centre registry. Baseline patient characteristics and echocardiographic data were compared between groups.

Results: Between December 2011 and February 2024, a total of 183 patients underwent mitral TEER. Of these, 140 patients were treated with early-generation MitraClip, and 43 patients were treated with the G4 system. Reduction of MR to grade≤1 was achieved in 59.5% of patients treated with the G4 MitraClip compared to 25.7% in the early-generation cohort (p<0.001). There was a significant reduction in median MR severity post-TEER in the G4 cohort compared to the early-generation group (p=0.006) (median change: 3 grades in the G4 group). There was no significant difference in post-TEER (moderate or severe) mitral stenosis (p=0.743). No significant difference was noted in the median number of clips used. No significant difference was noted in baseline characteristics, although a proportionally higher number of previous coronary interventions and coronary artery bypass grafts were observed in the early-generation MitraClip group.

Conclusions: The MitraClip G4 system achieved significantly greater reduction of MR severity compared to the earlier generation mitral TEER device.