{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:54:07Z","timestamp":1790902447804,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The PASCAL\u00ae transcatheter edge-to-edge repair system (TEER) is established for mitral regurgitation (MR), with the ACE iteration tailored for complex anatomies. Comparative data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare 3D mitral valve remodeling and procedural outcomes in patients undergoing TEER with PASCAL or PASCAL ACE device at a high-volume tertiary center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective, single-center study included 366 consecutive patients (mean age 77.7\u2009\u00b1\u200910.2\u00a0years; 57.9% male) with moderate-to-severe or severe MR treated between 2019 and 2024. Patients were stratified by device (ACE,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009128, PASCAL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009238). Procedural outcomes and 3D echocardiographic remodeling were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ACE-treated patients had more complex mitral anatomies and larger baseline mitral valve orifice areas (3D-MVOA, 6.55 [5.74\u20137.96] vs. 5.87 [4.86\u20137.38] cm\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Relative reduction in 3D-MVOA following the first device was similar between groups (ACE\u2009\u2212\u200944.5\u2009\u00b1\u20096.55% vs. PASCAL\u2009\u2212\u200945.9\u2009\u00b1\u20096.61%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.066) and consistent across functional, degenerative, and mixed MR subgroups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). ACE cases had a modestly smaller mean pressure gradient increase (+\u20091[0\u20131] vs.\u2009+\u20091[1, 2] mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046), likely reflecting larger residual MVOAs (3.81\u2009\u00b1\u20091.11 vs. 3.38\u2009\u00b1\u20091.07 cm\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Post-procedural annular remodeling by annular sphericity index was comparable (ACE 0.67\u2009\u00b1\u20090.09 vs. PASCAL 0.69\u2009\u00b1\u20090.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.119). Both devices achieved similarly high procedural success (ACE 100% vs. PASCAL 99.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.00) with no procedural complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world cohort, the ACE device was preferentially used in more complex mitral anatomies. Post-procedural MVOA was dictated by baseline valve anatomy rather than device configuration, with comparable relative MVOA reduction, annular remodeling, and procedural success, advocating for an anatomy-guided device selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-03031-0","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:42:50Z","timestamp":1790854970000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-dimensional mitral valve geometry after transcatheter edge-to-edge repair: PASCAL versus PASCAL-ACE\u2014implications for devices selection"],"prefix":"10.1007","author":[{"given":"Mohammed","family":"Abusharekh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Kampf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Schindhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"J\u00fcrgens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iryna","family":"Dykun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Al-Rashid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Totzeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tienush","family":"Rassaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2336-7991","authenticated-orcid":false,"given":"Amir Abbas","family":"Mahabadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"issue":"19","key":"3031_CR1","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1056\/NEJMoa2314328","volume":"391","author":"SD Anker","year":"2024","unstructured":"Anker SD, Friede T, von Bardeleben RS, Butler J, Khan MS, Diek M, Heinrich J, Geyer M, Placzek M, Ferrari R, Abraham WT, Alfieri O, Auricchio A, Bayes-Genis A, Cleland JGF, Filippatos G, Gustafsson F, Haverkamp W, Kelm M, Kuck KH, Landmesser U, Maggioni AP, Metra M, Ninios V, Petrie MC, Rassaf T, Ruschitzka F, Sch\u00e4fer U, Schulze PC, Spargias K, Vahanian A, Zamorano JL, Zeiher A, Karakas M, Koehler F, Lainscak M, \u00d6ner A, Mezilis N, Theofilogiannakos EK, Ninios I, Chrissoheris M, Kourkoveli P, Papadopoulos K, Smolka G, Wojakowski W, Reczuch K, Pinto FJ, Wiewi\u00f3rka \u0141, Kalarus Z, Adamo M, Santiago-Vacas E, Ruf TF, Gross M, Tongers J, Hasenfuss G, Schillinger W, Ponikowski P (2024) Transcatheter valve repair in heart failure with moderate to severe mitral regurgitation. 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TR has received honoraria, lecture fees, and\/or research support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiichi-Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, none of which are connected to this work. Additionally, AAM and TR are co-founders of mycor GmbH, specializing in AI-based ECG algorithm development. TR is also co-founder of Bimyo GmbH, focused on cardioprotective peptide development. MT reported speaker fees and personal support from Bayer, Daiichi Sankyo, BMS, Pfizer, Berlin Chemie, Novartis, Edwards, NovoNordisk, AstraZeneca outside the submitted work.\u00a0MT is supported by the Deutsche Forschungsgemeinschaft (GRK 2989) and the Deutsche Krebshilfe (BREATH consortium).","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"In this large real-world cohort, PASCAL ACE was used more frequently in patients with complex mitral valve anatomy and larger baseline valve orifice areas. Despite these differences, relative reductions in mitral valve orifice area, annular remodeling, and procedural success were comparable between PASCAL and PASCAL ACE. Post-procedural valve geometry and hemodynamics were primarily determined by baseline anatomy rather than device choice, supporting an anatomy-driven approach to device selection in mitral TEER.","order":2,"name":"Ethics","label":"Impact on daily practice","group":{"name":"EthicsHeading","label":"Declarations"}}]}}