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

Abstract

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 ( β =−0.410; P =0.001) and MitraClip cohorts ( β =−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.