Concept of the central clip: when to use one or two MitraClips®

Aims: Percutaneous edge-to-edge mitral valve repair with the MitraClip ® was shown to be a safe and feasible alternative compared to conventional surgical mitral valve repair. We analyse the concept of the central clip and the predictors for the need of more than one MitraClip ® in our high-risk surgical population with severe (47.5%) received two or more clips. Vena contracta (p<0.001) and the presence of two broad jets (p<0.001) were correlated with the need for a second clip. The presence of a restricted posterior mitral valve leaflet (PML) was inversely correlated with the need for more than one clip (p=0.02). A cut-off value of ≥7.5 mm for vena contracta predicted the need for a second clip (sensitivity 83%, specificity 90%, p=0.01). Conclusions: The central MitraClip ® concept achieved a significant reduction in the degree of mitral regur- gitation in the majority of patients treated. The presence of a broad jet (quantified by a vena contracta greater than 7.5 mm) significantly predicted the need for more than one clip.