Acute Changes in Mitral Annular Geometry After Transcatheter Edge-to-Edge Repair With PASCAL

Transcatheter edge-to-edge mitral valve repair (TEER) is an effective and safe method for treating high-risk patients with severe mitral regurgitation (MR). Two approved devices, MitraClip (Abbott Vascular) and PASCAL (Edwards Lifesciences), use leaflet approximation to reduce MR and may also influence annular dimensions via leaflet tension. The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long-term results.

A retrospective analysis was conducted on 115 high-risk patients (mean age 76 ± 11 years) with moderate-to-severe and severe MR (grade 3.9 ± 0.3, EROA 49± 23 mm², LV ejection fraction 47% ± 14%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6% ± 11.5%, EuroSCORE II 6.9% ± 5%, STS Score 5.5± 4.2). Intraprocedural transesophageal echocardiography (TOE) was post-analyzed using specialized software to assess mitral annular geometry.

PASCAL effectively reduced MR (grade 3.9 ± 0.3 to 1.2 ± 0.5, p < 0.001) in all patients. Significant reductions in 3D annulus area (15 ± 4cm² to 13.9 ± 4cm², 7.1% ± 9.9%, p < 0.001) and perimeter (14 ± 1.7 cm to 13.5 ± 1.8 cm, 3.2% ± 5.9%, p < 0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior-posterior (AP) diameter showed greater reduction (4.1 ± 0.6 cm to 3.8 ± 0.6 cm, p < 0.001, 6.3% ± 7.8%) compared to medial-lateral diameter (4.3 ± 0.5 cm to 4.2 ± 0.6 cm, p < 0.001, 3.2% ± 8%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105% ± 8% to 109% ± 10%, p = 0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (p = 0.001), while these patients also achieved optimal long-term echocardiographic results with mild MR (p = 0.019).

TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.