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Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison.

JACC. Cardiovascular interventions

Authors: Victor Mauri, Atsushi Sugiura, Max Spieker, Christos Iliadis, Patrick Horn, Can Öztürk, Christian Besler, Matthias Riebisch, Osamah Al-Hammadi, Tobias Ruf, Muhammed Gerçek, Christina Grothusen, Michael Mehr, Marc Ulrich Becher, Christoph Mues, Niklas Boeder, Felix Kreidel, Kai Friedrichs, Ralf Westenfeld, Daniel Braun, Stephan Baldus, Tienush Rassaf, Holger Thiele, Georg Nickenig, Jörg Hausleiter, Helge Möllmann, Malte Kelm, Volker Rudolph, Ralph Stephan von Bardeleben, Holger M Nef, Peter Luedike, Philipp Lurz, Roman Pfister

BACKGROUND: In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking.

OBJECTIVES: The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems.

METHODS: Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE).

RESULTS: Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562).

CONCLUSIONS: In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome.

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PMID: 36543448

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