Safety of multiple grasping attempts during transcatheter mitral valve repair with the PASCAL system

BACKGROUND: Multiple grasping attempts are routinely required during mitral valve transcatheter-edge-to-edge repairs (M-TEER) to achieve optimal leaflet capture and minimize mitral regurgitation (MR). Whether extensive grasping adversely affects procedural outcomes remains unknown. AIMS: We aimed to evaluate safety, procedural characteristics and durability of MR reduction in M-TEER procedures with low vs. high number of grasping attempts using the PASCAL system. METHODS: Consecutive patients with severe MR who underwent M-TEER using the PASCAL system between 2019 and 2024 at our center were analyzed. Procedures were stratified according to grasping attempts: ≤7 (≤80th percentile, median 4 [2;5]) vs. ≥8 (>80th percentile, median 10 [9;12], max. 22). Baseline, procedural, short- and latest outcomes, were compared between groups. RESULTS: Overall, 391 M-TEER procedures (mean age 77.7 ± 10.1 years, 57.5% male) were included. No single leaflet device attachment, leaflet injury or other device-related complication occurred in either group. Procedures with ≥8 attempts were longer (126 ± 47.6 min vs. 82.9 ± 43.3 min; p < 0.001) and associated with larger baseline EROA (0.48 [0.38;0.70] vs. 0.40 [0.30;0.50] cm CONCLUSION: Multiple grasping during M-TEER using the PASCAL system is safe and results in sustained MR reduction, high procedural success and latest outcomes comparable to procedures requiring fewer attempts.