The PASCAL transcatheter mitral valve repair system for the treatment of mitral regurgitation: another piece to the puzzle of edge-to-edge technique

Grasso, Carmelo; Rubbio, Antonio Popolo

doi:10.21037/jtd.2017.10.156

Cited by 24 publications

(15 citation statements)

References 19 publications

(14 reference statements)

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“…2017;9(12):4856-59. 19 Praz F, Braun D, Unterhuber M, Spirito A, Orban M, Brugger N, et al Edge-to-edge mitral valve repair with extended clip arms: early experience from a multicenter observational study. JACC Cardiovasc Interv.…”

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

“…This system also allows independent grasping of mitral leaflets and continuous left atrial pressure monitoring. 19 A recent study investigated MitraClip ® XTR in 107 patients (mean age, 76±9 years; 69% males) with functional (n=53; 50%), primary (n=40; 37%) or mixed etiology (n=14; 13%) MI. Of 102 patients (95.3%) who survived the procedure and were discharged with no need for surgery, 95 (93%) had MI ≤2+ and 79 (77%) MI ≤1+.…”

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

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Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Ribeiro¹,

Júnior²,

Abizaid³

2020

J Transcat Intervent

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Mitral insufficiency is one of the most common acquired heart valve diseases and a common cause of heart failure, often in response to mitral annulus dilation. In such cases, the condition is referred to as functional or secondary and may be associated with ischemic heart disease or other dilated cardiomyopathies of varying etiology. Mitral valve insufficiency is common among older patients or individuals with several comorbidities, who are often not eligible for conventional mitral valve surgery due to high risk of intraoperative death and complications. Surgical outcomes (valve repair or replacement) may also be limited, particularly in patients with functional mitral insufficiency (class IIb indication according to most international guidelines). Several less invasive clip-based transcatheter mitral valve repair techniques have been developed. These have been addressed in several randomized trials in the last few years, such as the EVEREST-II, the MITRA-FR and the COAPT trials. Positive COAPT trial outcomes supported the indication of mitral clip procedures in functional mitral regurgitation patients with favorable anatomy, who remain symptomatic despite optimal medical treatment. Patients with "disproportionate" mitral insufficiency (i.e., large degree of mitral regurgitation relative to ventricular dysfunction) are those who benefit most from the intervention, with lower rates of hospital readmission and death. These outcomes prompted the incorporation of novel technologies (MitraClip® NTR, MitraClip® XTR and Pascal). Major features of these devices, such as longer clip arms, capability of independent grasping of anterior and posterior leaflets, and wider arm width range are reviewed in detail in this article.

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Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Ribeiro¹,

Júnior²,

Abizaid³

2020

J Transcat Intervent

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“…PASCAL Transcatheter MV Repair: The PASCAL TMVr (Edwards Lifesciences, Irvine, CA) system is designed to overcome shortcomings of the MitraClip system by facilitating easy steering within the left atrium, larger implant size, broader paddles with central spacer within device to reduce MR by maximizing leaflet coaptation, ability to grasp individual leaflets and implant elongation to promote safe subvalvular maneuvering (63). Placement of the device occurs via transvenous access (femoral) and transseptal approach similar to the MitraClip.…”

Section: Management Of Chronic Mrmentioning

confidence: 99%

Percutaneous Mitral Valve Interventions (Repair): Current Indications and Future Perspectives

Shah

Jorde

2019

Front. Cardiovasc. Med.

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Mitral valve regurgitation (MR) is the commonest valvular abnormality encountered among adult patients with cardiac valvular disease and conveys significant morbidity and mortality. The mitral valve is a complex anatomical structure and etiology for regurgitation is classified as either primary or secondary MR. Identification of the etiology in severe MR is critical in determining the appropriate treatment strategy. Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for treatment of selected patients with symptomatic chronic moderate-severe or severe (3 to 4+) MR. While surgery remains the mainstay for treatment in primary MR, several technological advances within the last decade have made transcatheter mitral valve intervention increasingly feasible and safe in clinical practice. Use of TMVR in patients with severe MR has successfully reduced patient symptoms, disease morbidity, improved quality of life, and facilitated reverse remodeling with potential for a survival advantage among certain patients with secondary MR. Recent randomized controlled trials on MitraClip use in secondary MR have reinvigorated interest in this disease and refocused our attention on optimizing patient selection and timing of intervention to maximize benefit from using such percutaneous devices. In our review, we discuss etiologies and pathophysiology in both acute MR and development of chronic severe MR. We discuss management strategies for MR among patients based on etiology, particularly percutaneous mitral valve interventional therapies. We perform an extensive review comparing and contrasting existing data on safety, efficacy, durability, and appropriate patient selection related to MitraClip implantation in both primary and secondary MR. Lastly, we explore percutaneous MV therapies beyond the MitraClip as we await larger scale trials on these devices prior to them making way into day-to-day practice.

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“…This device was studied for the treatment of mitral regurgitation and gained a CE mark in 2019. Some clinicians have used it for the treatment of TR according to the compassionate-use program with promising results [4, 34, 35].…”

Section: Transcatheter Therapy For the Treatment Of Trmentioning

confidence: 99%

The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming

Oliveira

Oliveira²

2019

Cardiol Res

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The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!

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The PASCAL transcatheter mitral valve repair system for the treatment of mitral regurgitation: another piece to the puzzle of edge-to-edge technique

Cited by 24 publications

References 19 publications

Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Percutaneous Mitral Valve Interventions (Repair): Current Indications and Future Perspectives

The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming

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