Abstract only Introduction: MitraClip, an efficacious strategy for patients with heart failure and severe mitral regurgitation, can be complicated by acute circulatory collapse in rare instances. Data on the use of mechanical circulatory support (MCS) in these patients is scarce. Methods: Using the Nationwide Inpatient Sample Database from 2016 to 2018, we identified patients who underwent MitraClip insertion and required MCS using ICD-10 codes. The MCS devices included intra-aortic balloon pump (IABP) (group 1), Impella (group 2), and extracorporeal membrane oxygenation (ECMO) (group 3). Patients <18 years and those requiring more than one device use were excluded. The primary outcome was in-hospital mortality and secondary outcomes were myocardial infarction (MI), cerebrovascular accident, sepsis, and major bleeding. Results: Our analysis included 17,070 MitraClip patients (based on weighted sample) with 360 requiring MCS devices (IABP N=270, Impella N=75, ECMO N=15). Patients who required Impella were older than those who required ECMO and IABP (mean age group 1 75.8 ± 11.3, group 2 78.3 ± 10.1, group 3 77.1 ± 8.9; p < 0.0001). The utilization of MCS devices was different among races (Whites 80.8%, African Americans 7.6%, Hispanics 6.53%; p = 0.0078) but not among gender (males 52.3%; p = 0.8467). Incidence of in-hospital mortality was highest in Impella (group 1 31.5%, group 2 46.7%, none in group 3; p < 0.001) (Figure). The multivariate logistic regression model adjusted for MCS devices, age, race, sex, hypertension, diabetes, cardiopulmonary disease, kidney disease (CKD), liver disease, peripheral arterial disease, and arrhythmias indicated that the use of IABP, Impella, CKD, and liver disease were independent predictors of in-hospital mortality. Conclusions: In MitraClip, the use of ECMO was associated with a higher incidence of major bleeding and sepsis when compared to Impella and IABP, however, Impella use was associated with higher in-hospital mortality and MI.