Cardiac remodelling and clinical outcomes after mitral edge-to-edge repair with the PASCAL® system

Chronic mitral regurgitation (MR) causes haemodynamic and myocardial changes leading to increased left atrial volume and left ventricular preload and finally eccentric hypertrophy of the left ventricle. The extent to which mitral valve transcatheter edge-to-edge repair induced haemodynamic improvements translates into reverse remodelling and clinical benefit remains to be clarified. This project aimed to investigate periprocedural haemodynamic changes during mitral valve transcatheter edge-to-edge repair, their effects on reverse cardiac remodelling, and the associated effects on heart failure-related hospitalization and all-cause mortality.

In this retrospective study, 130 patients with severe symptomatic MR underwent transcatheter edge-to-edge repair. Haemodynamic parameters were assessed pre- and immediately post-procedure, and echocardiography was performed at 6-12 months (median 188 days, IQR 26). Clinical follow-up included 1-year heart failure hospitalization and all-cause mortality. Short-term haemodynamic data were available in 86 patients and long-term echocardiographic follow-up in 73, with incomplete datasets excluded from the respective analyses. Mitral valve transcatheter edge-to-edge repair significantly improved cardiac index (+11.37%, P < 0.01) and reduced left atrial pressures (-36.97%, P < 0.01). Echocardiography demonstrated reduced left ventricular end-diastolic diameter (-2.8 mm, -4.0%, P = 0.004) and improved right ventricular function (+5.8%, P = 0.019) at follow-up. Patients with improved left ventricular global longitudinal strain had lower mortality and hospitalization rates.

Mitral valve transcatheter edge-to-edge repair with the PASCAL® system is linked with immediate haemodynamic improvements that may be associated with reverse cardiac remodelling and improved mid-term clinical outcomes. Monitoring acute haemodynamic effects may help predict positive remodelling and outcome effects.