{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:34:55Z","timestamp":1790710495927,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Residual mitral regurgitation (rMR) \u22641+ has been associated with improved 1-year outcomes after mitral valve transcatheter edge-to-edge repair, regardless of the mean mitral pressure gradient (MPG). Prior evidence is limited to 30-day echocardiographic follow-up and patients treated with the MitraClip (Abbott Structural Heart). Whether rMR and MPG assessed at discharge are associated with outcomes after PASCAL mitral valve transcatheter edge-to-edge repair (Edwards Lifesciences) remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>REPAIR (Registry of Pascal for Mitral Regurgitation) is an investigator-initiated, multicenter registry including all consecutive patients treated with PASCAL mitral valve transcatheter edge-to-edge repair. Based on discharge echocardiography, patients were stratified into 4 groups: optimal (rMR \u22641+, MPG &lt;5 mm\u2009Hg), MPG-suboptimal (rMR \u22641+, MPG \u22655 mm\u2009Hg), rMR-suboptimal (rMR \u22652+, MPG &lt;5 mm\u2009Hg), and dual-suboptimal (rMR \u22652+, MPG \u22655 mm\u2009Hg). The primary end point was 1-year mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 2172 patients (median follow-up, 463 days [Q1\u2013Q3, 357\u2013815]), 59.4% were classified as optimal, 12.2% MPG-suboptimal, 21.3% rMR-suboptimal, and 7.0% dual-suboptimal. One-year mortality differed significantly across groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), with the lowest rate in the optimal (8.7% [95% CI, 6.8%\u201310.5%]) and highest in the dual-suboptimal group (20.1% [95% CI, 12.0%\u201327.4%];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic toggle=\"yes\">Bonferroni<\/jats:italic>\n                      <\/jats:sub>\n                      &lt;0.001). rMR \u22641+ was associated with lower 1-year mortality (hazard ratio, 0.54 [95% CI, 0.37\u20130.74];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and remained significant, independent of dichotomized (MPG, &lt;5 versus \u22655 mm\u2009Hg) or continuous MPG. Dichotomized MPG was not significantly associated with 1-year mortality (hazard ratio, 0.73 [95% CI, 0.51\u20131.04];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.078), whereas continuous MPG was (hazard ratio per mm\u2009Hg increase, 1.10 [95% CI, 1.00\u20131.21];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.048) with a trend after adjusting for rMR \u22641+ (adjusted hazard ratio per mm\u2009Hg increase, 1.07 [95% CI, 0.98\u20131.18];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.145). No interaction was observed between rMR \u22641+ and dichotomized\/continuous MPG (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      &gt;0.450).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Discharge rMR \u22641+ is independently associated with lower 1-year mortality after PASCAL mitral valve transcatheter edge-to-edge repair. Although MPG was not independently associated, modestly elevated gradients may be acceptable when rMR \u22641+ is achieved, but should still warrant clinical attention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.drks.de\">https:\/\/www.drks.de<\/jats:ext-link>\n                      ; Unique identifier: DRKS00033959.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015845","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T16:50:09Z","timestamp":1761670209000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Relation of Residual Mitral Regurgitation and Gradient Following Mitral Valve Transcatheter Edge-to-Edge Repair"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"drks00033959","registry":"10.18810\/drks"}],"author":[{"given":"Donika","family":"Mustafa","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany (D.M., J.S., H.G., S.B., R.P., V.M., P. von Stein)."},{"name":"Center for Cardiovascular Medicine ABCD, Germany (D.M., J.S., J.M.H., A.S., P.H., M.W., H.G., S.B., R.P., V.M., P. von Stein)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3871-164X","authenticated-orcid":true,"given":"Jennifer","family":"von Stein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany (D.M., J.S., H.G., S.B., R.P., V.M., P. von Stein)."},{"name":"Cardiovascular Research Foundation, NY (J.S., G.A., J.F.G., P. von Stein)."},{"name":"Center for Cardiovascular Medicine ABCD, Germany (D.M., J.S., J.M.H., A.S., P.H., M.W., H.G., S.B., R.P., V.M., P. von Stein)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-1493","authenticated-orcid":true,"given":"Lukas","family":"Stolz","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Germany (L.S., J.H.)."},{"name":"Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Germany (L.S., J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8606-3595","authenticated-orcid":true,"given":"Jean Marc","family":"Haurand","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Medicine ABCD, Germany (D.M., J.S., J.M.H., A.S., P.H., M.W., H.G., S.B., R.P., V.M., P. von Stein)."},{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital D\u00fcsseldorf, Medical Faculty of the Heinrich Heine University D\u00fcsseldorf, Germany (J.M.H., P.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4082-3901","authenticated-orcid":true,"given":"Matthias","family":"Gr\u00f6ger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Ulm University Heart Center, Germany (M. 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