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Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA\u2009\u2265\u20093.5cm<jats:sup>2<\/jats:sup> were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Seventy-two patients (81.0 years, IQR {74.3\u201385.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity (<jats:italic>p<\/jats:italic>\u2009=\u20090.66), MR reduction (<jats:italic>p<\/jats:italic>\u2009=\u20090.73), and body surface area (<jats:italic>p<\/jats:italic>\u2009=\u20090.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0\u2009\u00b1\u20091.1 vs. 5.4\u2009\u00b1\u20091.3cm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009=\u20090.18), however, residual MVOA was larger in these patients (2.7\u2009\u00b1\u20090.7 vs. 2.3\u2009\u00b1\u20090.6cm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (\u2212\u200945.9\u2009\u00b1\u20097.6 vs.\u2009\u2212\u200956.3\u2009\u00b1\u20097.0%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n            <jats:p>Seventy-two patients treated\u00a0for functional mitral regurgitation (FMR) with the narrower PASCAL Ace\u00a0featuring a smaller spacer (<jats:italic>n<\/jats:italic>\u2009=\u200940) or\u00a0the broader P10\u00a0with a larger spacer\u00a0(<jats:italic>n<\/jats:italic>\u2009=\u200932)  were included in this study. Using 3D TEE and multiplanar reconstruction for direct planimetry, mitral valve orifice areas (MVOA) were measured before and after device implantation. Only patients with central device positioning were included. The dimensions of the PASCAL device platform are shown as well. Note the larger space and broader design of the P10 compared to the PASCAL Ace. The difference in MVOA reduction amounted to 10%, which translates into roughly 0.5 cm<jats:sup>2<\/jats:sup> based on an average MV found in this study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00392-023-02368-0","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T11:47:19Z","timestamp":1706183239000},"page":"809-817","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area"],"prefix":"10.1007","volume":"114","author":[{"given":"Michael","family":"Paukovitsch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Felbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Tadic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"Ke\u00dfler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinny","family":"Scheffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Gr\u00f6ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinisa","family":"Markovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4725-6217","authenticated-orcid":false,"given":"Wolfgang","family":"Rottbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonhard Moritz","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"issue":"4","key":"2368_CR1","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1067\/mtc.2001.117277","volume":"122","author":"O Alfieri","year":"2001","unstructured":"Alfieri O, Maisano F, De Bonis M et al (2001) The double-orifice technique in mitral valve repair: a simple solution for complex problems. 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All patients provided written informed consent allowing data collection. The authors declare no competing interests.\u00a0All relevant data is included within this manuscript.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}