{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:35:47Z","timestamp":1788914147547,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Transcatheter edge\u2010to\u2010edge mitral valve repair (TEER) is an effective and safe method for treating high\u2010risk patients with severe mitral regurgitation (MR). Two approved devices, MitraClip (Abbott Vascular) and PASCAL (Edwards Lifesciences), use leaflet approximation to reduce MR and may also influence annular dimensions via leaflet tension. The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long\u2010term results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on 115 high\u2010risk patients (mean age 76\u00a0\u00b1\u00a011 years) with moderate\u2010to\u2010severe and severe MR (grade 3.9\u00a0\u00b1\u00a00.3, EROA 49\u00b1\u00a023\u00a0mm<jats:sup>2<\/jats:sup>, LV ejection fraction 47%\u00a0\u00b1\u00a014%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6%\u00a0\u00b1\u00a011.5%, EuroSCORE II 6.9%\u00a0\u00b1\u00a05%, STS Score 5.5\u00b1\u00a04.2). Intraprocedural transesophageal echocardiography (TOE) was post\u2010analyzed using specialized software to assess mitral annular geometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PASCAL effectively reduced MR (grade 3.9\u00a0\u00b1\u00a00.3 to 1.2\u00a0\u00b1\u00a00.5, <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001) in all patients. Significant reductions in 3D annulus area (15\u00a0\u00b1\u00a04cm<jats:sup>2<\/jats:sup> to 13.9\u00a0\u00b1\u00a04cm<jats:sup>2<\/jats:sup>, 7.1%\u00a0\u00b1\u00a09.9%, <jats:italic>p<\/jats:italic>\u00a0<jats:italic>&lt;\u00a0<\/jats:italic>0.001) and perimeter (14\u00a0\u00b1\u00a01.7\u00a0cm to 13.5\u00a0\u00b1\u00a01.8\u00a0cm, 3.2%\u00a0\u00b1\u00a05.9%, <jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior\u2013posterior (AP) diameter showed greater reduction (4.1\u00a0\u00b1\u00a00.6\u00a0cm to 3.8\u00a0\u00b1\u00a00.6\u00a0cm, <jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>0.001, 6.3%\u00a0\u00b1\u00a07.8%) compared to medial\u2013lateral diameter (4.3\u00a0\u00b1\u00a00.5\u00a0cm to 4.2\u00a0\u00b1\u00a00.6\u00a0cm, <jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>0.001, 3.2%\u00a0\u00b1\u00a08%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105%\u00a0\u00b1\u00a08% to 109%\u00a0\u00b1\u00a010%, <jats:italic>p\u00a0=\u00a0<\/jats:italic>0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001), while these patients also achieved optimal long\u2010term echocardiographic results with mild MR (<jats:italic>p\u00a0=\u00a0<\/jats:italic>0.019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.70279","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:00:27Z","timestamp":1756368027000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Changes in Mitral Annular Geometry After Transcatheter Edge\u2010to\u2010Edge Repair With PASCAL"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7356-2379","authenticated-orcid":false,"given":"Konstantinos","family":"Papadopoulos","sequence":"first","affiliation":[{"name":"Transcatheter Heart Valves Department HYGEIA Hospital  Athens Greece"},{"name":"Echocardiography Department European Interbalkan Medical Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chrissoheris","sequence":"additional","affiliation":[{"name":"Transcatheter Heart Valves Department HYGEIA Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionysios","family":"Aravantinos","sequence":"additional","affiliation":[{"name":"Transcatheter Heart Valves Department HYGEIA Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignatios","family":"Ikonomidis","sequence":"additional","affiliation":[{"name":"Echocardiography Laboratory Second Cardiology Department National and Kapodistrian University of Athens Attikon University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Spargias","sequence":"additional","affiliation":[{"name":"Transcatheter Heart Valves Department HYGEIA Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani A.","family":"Vannan","sequence":"additional","affiliation":[{"name":"Structural and Valvular Center of Excellence Marcus Heart Valve Center Piedmont Heart 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