Interventions for valvular disease and heart failure

Transcatheter edge-to-edge mitral valve repair with the PASCAL system: early results from a real-world series

EuroIntervention 2020;16:824-832. DOI: 10.4244/EIJ-D-20-00216

Christian Besler
Christian Besler1, MD; Thilo Noack2, MD; Maximilian von Roeder1, MD; Mitsunobu Kitamura1, MD; Karl-Patrik Kresoja1, MD; Anna Flo Forner3, MD; Carmine Bevilacqua3, MD; Steffen Desch1, MD; Joerg Ender3, MD; Michael A. Borger2, MD, PhD; Holger Thiele1, MD; Philipp Lurz1, MD, PhD
1. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; 2. Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; 3. Department of Anaesthesiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany

Aims: This study sought to characterise the real-world performance and clinical outcomes of the PASCAL system, a leaflet approximation device for transcatheter mitral valve repair.

Methods and results: Fifty patients in NYHA Class II-IV despite optimal medical therapy (median age 78.0 years [IQR 74.5-81.0], 52% female, log EuroSCORE 21.6 [IQR 13.2-30.2]) were treated for severe mitral regurgitation (MR) and followed up for one month. Primary and secondary MR was present in 24% and 68% of patients, respectively, with a mixed aetiology observed in 8%. A 1-device strategy was employed in 26/50 patients (52%), a 2-device strategy in 23/50 (46%) patients, and a 3-device strategy in 1/50 (2%) patients. Technical and procedural success was achieved in 100% and 98% of patients, respectively. MR grade ≤1 was observed in 39/50 (78%) patients at discharge, and in 36/46 (78%) patients at one month, with transvalvular gradients remaining ≤5 mmHg in all patients. One device embolisation and one single leaflet device attachment were observed during follow-up. After one month, 73% of patients reported an improvement in NYHA class, and six-minute walk test distance increased by 73±12 m in patients without relevant tricuspid regurgitation.

Conclusions: In a real-world population, the PASCAL device effectively reduces MR and leads to functional improvements on short-term follow-up.

Visual summary. PASCAL system in mitral regurgitation.

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dyspnoeaelderly (>75 years)mitral regurgitationmitral valve repair
Interventions for valvular diseaseInterventions for heart failureMitral valve replacement and repairChronic heart failure
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