The PASCAL P10 system for mitral valve transcatheter edge-to-edge repair has undergone iterations, including introduction of the narrower Ace implant and the Precision delivery system. The study sought to evaluate outcomes and the impact of PASCAL mitral valve transcatheter edge-to-edge repair device iterations. The REPAIR (REgistry of PAscal for mltral Regurgitation) study is an investigator-initiated, multicenter registry including consecutive patients with mitral regurgitation (MR) treated from 2019 to 2024. Patients were stratified by device iteration: P10_only, P10/Ace_Gen1 (introduction of Ace), and P10/Ace_Prec (introduction of Precision). The primary endpoint was MR ≤1+ at discharge; secondary endpoints included technical success and MR durability (discharge vs 30 days, 1 year, and 2 years). A total of 2,165 patients (mean age 78 ± 10 years, 44% female, 85% in NYHA functional class ≥III, EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 4.9% [Q1-Q3: 3.0% to 8.1%]) were included: 660 P10_only, 945 P10/Ace_Gen1, and 560 P10/Ace_Prec. Median follow-up was 510 days (Q1-Q3: 369-874 days). Primary (47% [n = 1,019 of 2,142]) and secondary (52% [n = 1,123 of 2,142]) MR etiology did not change across device iterations (P = 0.547). Technical success was achieved in 97.0% (n = 2,099 of 2,165) with similar rates across device iterations (P = 0.290). MR ≤1+ was achieved in 72% (n = 1,397 of 2,085), improving with device iterations (P10_only: 66% [n = 422 of 638], P10/Ace_Gen1: 73% [n = 661 of 906], P10/Ace_Prec: 77% [n = 414 of 541]; P < 0.001). MR grades of ≤1+ and ≤2+ slightly worsened at 30 days, 1 year, and 2 years, primarily in patients with primary MR, with no differences across iterations. Device iterations of the PASCAL system resulted in increasing rates of achieving MR reduction to ≤1+ at discharge, with stable and high technical success rates. A slight deterioration of the initial result warrants further investigation.

Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences). The authors sought to evaluate and compare outcomes of SMR phenotypes undergoing M-TEER. REPAIR (REgistry of PAscal for mItral Regurgitation) is an investigator-initiated, multicenter registry of patients undergoing M-TEER. aSMR was defined by left atrial dilation with preserved left ventricular size and ejection fraction. Outcomes included MR ≤1+ at discharge, technical success, NYHA functional class improvement, and 1-year survival. Among 915 patients (166 [18%] aSMR, 749 [82%] vSMR), the median follow-up was 491 days (Q1-Q3: 360-833 days). MR ≤1+ was achieved in 77.2% vs 71.4% (P = 0.162), with technical success in 97.0% vs 98.3% (P = 0.446). NYHA functional class improved in both phenotypes (P < 0.001), with 61.2% vs 61.3% in functional class ≤II at follow-up (P > 0.999). One-year survival was 88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%; P = 0.346). In aSMR patients, 1-year survival was significantly lower in patients with baseline tricuspid regurgitation (TR) grade ≥moderate compared with those with <moderate TR (84.3% [95% CI: 77.0%-92.3%] vs 100.0% [95% CI: 100.0%-100.0%]; P = 0.041). In vSMR patients, survival was similar between ≥moderate and <moderate baseline TR (83.9% [95% CI: 79.8%-88.2%] vs 89.3% [95% CI: 85.0%-93.8%]; P = 0.051). M-TEER effectively reduces MR to ≤1+ and improves symptoms in both aSMR and vSMR. Particularly in aSMR, ≥moderate baseline TR is linked to worse outcomes, warranting consideration as an additional treatment target.

The GLIDE Score is an anatomical scoring system designed to predict moderate residual tricuspid regurgitation (TR) immediately following transcatheter tricuspid edge-to-edge repair (T-TEER). The purpose of this study was to evaluate the GLIDE Score's predictive capability for achieving a postprocedural TR grade of mild or better. This retrospective analysis included 336 patients from a multicenter registry who underwent T-TEER between January 2017 and November 2022. Anatomical features were assessed using transesophageal echocardiography to calculate the GLIDE Score, which ranges from 0 to 5. The primary endpoint was a postprocedural TR grade of mild or better, assessed via periprocedural imaging. Outcomes were compared between patients with GLIDE Scores of 0 to 1 and those with scores ≥2 using logistic regression and ROC curve analysis. Median age was 81 years, with no significant differences in BMI, EuroScore II, or NYHA Class across GLIDE Score cohorts. The GLIDE Score ≥2 cohort had a larger median RV basal diameter (48 mm vs 45 mm, P < 0.001) and more torrential TR cases (35.9% vs 3.1%, P < 0.001). Postprocedural mild TR was achieved in 74.7% of patients with a GLIDE Score of 0 to 1, versus 13.4% in the ≥2 cohort (P < 0.001). Ordinal regression analysis found a strong correlation between the GLIDE Score and postprocedural TR severity (coefficient = 1.41, t = 12.92), with an AUC to predict mild TR of 0.87 (95% CI: 0.83-0.90). The GLIDE Score is a valuable tool for predicting postprocedural TR severity in T-TEER patients, guiding patient selection and refining treatment strategies.