The following is a summary of “Effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area,” published in the January 2024 issue of Cardiology by Paukovitsch et al.
Mitral transcatheter edge-to-edge repair (M-TEER) is a recognized therapy for functional mitral regurgitation (FMR) but poses a risk of iatrogenic stenosis.
Researchers conducted a retrospective study to assess the effect of P10’s larger spacer compared to Ace’s smaller spacer on mitral valve orifice area (MVOA) reduction in M-TEER.
They screened consecutive patients undergoing M-TEER for severe FMR, selecting those with a single PASCAL device implantation in central MV leaflet segments, non-complex anatomy, and baseline MVOA ≥ 3.5cm2. Intraprocedural transesophageal echocardiography compared MVOA reduction using 3D multiplanar reconstruction and direct planimetry without adhering to a predefined MVOA threshold for device selection.
The result showed that 72 patients were included (mean age 81.0 years, IQR {74.3–85.0}), and 32 (44.4%) received P10 implants. There were no significant differences in MR severity (P=0.66), MR reduction (P=0.73), or body surface area (P=0.56) between groups. Baseline MVOA tended to be smaller in P10 patients with larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm2, P=0.18), residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm2, P=0.03). The reduction in relative MVOA was notably lower in patients treated with P10 (−45.9 ± 7.6 vs. −56.3 ± 7.0%, p < 0.01). Ace patients exhibited more pronounced indirect annuloplasty, while mean transmitral gradients were similar across groups.
Investigators concluded that in FMR with small MVOAs, Pascal Ace may risk significant orifice narrowing and even stenosis compared to P10’s larger spacer size.
Source: link.springer.com/article/10.1007/s00392-023-02368-0