Triple versus Double Orifice Valves After Transcatheter Edge-to-Edge Repair: Clinical Features and Outcomes

Author(s): Maia Eng, Lily Chen, Benjamin Stripe, Thomas W. Smith, Edris Aman, Dali Fan, Gagan D. Singh, Jason H. Rogers

Rationale: Procedural and clinical outcomes of triple orifice valves created by mitral valve transcatheter edge-to-edge repair (TEER) have not been previously characterized.

Methods: 201 patients undergoing MitraClip were retrospectively analyzed from 2014-2019 (before generation 4 MitraClip release). A triple orifice valve was defined as having three orifices with all diastolic inflow diameters > 4 mm (the width of a non-XTW/NTW MitraClip). We reviewed pre- and post-procedure pressure gradients, hemodynamic parameters, and mitral regurgitation (MR) grades in triple vs. double orifice valves.

Results: Patients with triple orifice valves after MitraClip (n=13) had lower baseline mean pressure gradients across the mitral valve compared to double orifice valves, although this difference was not significant (1.4 ± 0.8 vs 1.8 ±.2 mmHg, p = 0.15). They also did not have significantly different post-procedure gradients (5.0 ± 2.8 vs 4.6 ±2.2 mmHg, p = 0.59). MR grade pre- and post-TEER was similar between the two groups. Procedural hemodynamic parameters were also similar between the two groups.

Conclusions: In this single center retrospective study, we found that the creation of a triple orifice mitral valve after MitraClip had a comparable impact on the final gradients when compared to double orifice, perhaps due to lower baseline gradients. Overall MR reduction was similar. The need to create triple orifice valves in selected patients is often driven by more complex baseline disease with multiple or wide jets.