One‐Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge‐to‐Edge Repair With the PASCAL System: Results From a Multicenter Registry

Abstract

Background We previously reported procedural and 30‐day outcomes of a German early multicenter experience with the PASCAL system for severe mitral regurgitation (MR). This study reports 1‐year outcomes of mitral valve transcatheter edge‐to‐edge repair with the PASCAL system according to MR etiology in a large all‐comer cohort. Methods and Results Clinical and echocardiographic outcomes up to 1‐year were investigated according to MR etiology (degenerative [DMR], functional [FMR], or mixed [MMR]) in the first 282 patients with symptomatic MR 3+/4+ treated with the PASCAL implant at 9 centers in 2019. A total of 282 patients were included (33% DMR, 50% FMR, 17% MMR). At discharge, MR reduction to ≤1+/2+ was achieved in 58%/87% of DMR, in 75%/97% of FMR, and in 78%/98% of patients with MMR ( P =0.004). MR reduction to ≤1+/2+ was sustained at 30 days (50%/83% DMR, 67%/97% FMR, 74%/100% MMR) and at 1 year (53%/78% DMR, 75%/97% FMR, 67%/91% MMR) with significant differences between etiologies. DMR patients with residual MR 3+/4+ at 1‐year had at least complex valve morphology in 91.7%. Valve‐related reintervention was performed in 7.4% DMR, 0.7% FMR, and 0.0% MMR ( P =0.010). At 1‐year, New York Heart Association Functional Class was significantly improved irrespective of MR etiology ( P <0.001). Conclusions In this large all‐comer cohort, mitral valve transcatheter edge‐to‐edge repair with the PASCAL system was associated with an acute and sustained MR reduction at 1‐year in all causes. However, in patients with DMR, MR reduction was less pronounced, reflecting the high incidence of complex or very complex anatomies being referred for mitral valve transcatheter edge‐to‐edge repair.

The State of M‐TEER: Enjoy the Fruit Salad!

“…In this issue of the Journal of the American Heart Association ( JAHA ), Von Stein and colleagues have published a German multicenter registry examining the 1‐year outcomes of the PASCAL M‐TEER repair system and their real‐world results across 282 consecutive patients. 9 In this article, the 1‐year echocardiographic outcomes are stratified by mitral valve pathogenesis defined as functional MR, degenerative MR, or mixed MR. The findings demonstrate that 1‐year echocardiographic results are impacted by the cause of MR, with <2+ MR in 97% of the functional MR group and the mixed MR group, while the degenerative MR cohort showed far less favorable results, with only 78% achieving <2+ MR. As stated by the authors, this less pronounced reduction in MR reflects the “high incidence of complex or very complex anatomies being referred for M‐TEER.”…”