Short-Term Effects of Different Transcatheter Edge-to-Edge Devices on Mitral Valve Geometry

BACKGROUND: Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might allow for an advanced analysis of predictors for mean transmitral gradients. METHODS AND RESULTS: Consecutive patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation using PASCAL or MitraClip systems were included. Quantification of short-term MV changes throughout the cardiac cycle was performed using peri-interventional 3-dimensional MV images. Predictors for mean transmitral gradients were identified in univariable and multivariable regression analysis. Long-term results were described during 1-year follow-up. A total of 100 patients undergoing transcatheter edge-to-edge repair using PASCAL (n= 50) or MitraClip systems (n=50) were included. Significant reductions of anterior-posterior diameter, annular circumference, and area throughout the cardiac cycle were found in both cohorts (P<0.05 for all). Anatomic MV orifice area remained larger in the PASCAL cohort in mid (2.8 +/- 1.0 versus 2.4 +/- 0.9 cm(2); P=0.049) and late diastole (2.7 +/- 1.1 versus 2.2 +/- 0.8 cm(2); P=0.036) compared with the MitraClip cohort. Besides a device-specific profile of independent predictor of mean transmitral gradients, reduction of middiastolic anatomic MV orifice area was identified as an independent predictor in both the PASCAL (beta=- 0.410; P= 0.001) and MitraClip cohorts (beta=- 0.318; P=0.028). At follow-up, reduction of mitral regurgitation grade to mild or less was more durable in the PASCAL cohort (90% versus 72%; P=0.035). CONCLUSIONS: PASCAL and MitraClip showed comparable short-term effects on MV geometry. However, PASCAL might better preserve MV function and demonstrated more durable mitral regurgitation reduction during follow-up. Identification of independent predictors for mean transmitral gradients might potentially help to guide device selection in the future.

Automated summary

The short-term effects on mitral valve anatomy after transcatheter edge-to-edge repair using the PASCAL system are comparable to the MitraClip system. However, PASCAL may better preserve mitral valve function and show more durable reduction of mitral regurgitation during follow-up.