Acute anatomic and hemodynamic impact of mitral TEER: G4 MitraClip vs. PASCAL

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transcatheter mitral edge-to-edge repair (TEER) represents a safe and effective alternative to surgery for high-risk patients suffering from symptomatic severe mitral regurgitation (MR). New devices and new device iterations are constantly developed and their impact on the mitral valve (MV) anatomy should be regularly evaluated to provide the best patient-tailored approach in the future. Purpose The purpose of this study was to compare the acute anatomic and hemodynamic effects of the worldwide most implanted commercially available TEER devices: the Abbott G4 MitraClip (MC) vs. the Edwards PASCAL. Methods Consecutive patients from our mitral registry treated by TEER were included. High quality volume datasets focused on the MV were acquired during each intervention. Mean transvalvular gradient (Gd) corrected for the heart rate (HR), 3D mitral valve area (MVA) and anteroposterior diameter (AP) of MV annulus were evaluated before and after the implantation of each device; remaining orifices created after implantation were measured independently and summed. Results Eighty patients were included in this analysis; the majority were treated with "bulky" first devices: PASCAL P10 (10mm wide) or MC NTW/XTW (6mm wide). Individuals treated with MC exhibited higher MVA before clipping, however there were no differences in the AP diameter of the annulus between both groups. The first device produced a significantly higher reduction of MVA in the MC group, while no difference in MVA reduction was seen after the second implant. The impact on the AP-diameter (i.e., the indirect annuloplasty) and on the transvalvular corrected Gd after one or two devices was not significantly different between groups despite the smaller native MVA in the PASCAL population. Conclusion The design differences between both devices with an active closure for MC and a passive one for PASCAL (possibly leading to a lower tension on the leaflets) could explain the lower impact of the latter on the MVA, despite the wider arms of the P10. A study including a higher number of patients is needed to confirm these findings, which may affect patient selection according to the native MVA and the treatment strategy.