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Muhammed Gerçek, Fabian Roder, Tanja Rudolph, Vera Fortmeier, Armin Zittermann, Volker Rudolph, Kai Friedrichs

• \(\bf Background\) The PASCAL system is a novel device for edge-to-edge treatment of mitral regurgitation (MR). The aim of this study was to compare the safety and efficacy of the PASCAL to the MitraClip system in a highly selected group of patients with complex primary mitral regurgitation (PMR) defined as effective regurgitant orifice area (MR-EROA) \(\geq\)  0.40 \(cm^{2}\), large flail gap (\(\geq\) 5 mm) or width (\(\geq\) 7 mm) or Barlow's disease. \(\bf Methods\) 38 patients with complex PMR undergoing mitral intervention using PASCAL (\(\it n\) = 22) or MitraClip (\(\it n\) = 16) were enrolled. Primary efficacy endpoints were procedural success and degree of residual MR at discharge. The rate of major adverse events (MAE) according to the Mitral Valve Academic Consortium (MVARC) criteria was chosen as the primary safety endpoint. \(\bf Results\) Patient collectives did not differ relevantly regarding pertinent baseline parameters. Patients´ median age was 83.0 [77.5–85.3] years (PASCAL) and 82.5 [76.5–86.5] years (MitraClip). MR-EROA at baseline was 0.70 [0.68–0.83] \(cm^{2}\) (PASCAL) and 0.70 [0.50–0.90] \(cm^{2}\) (MitraClip), respectively. 3D-echocardiographic morphometry of the mitral valve apparatus revealed no relevant differences between groups. Procedural success was achieved in 95.5% (PASCAL) and 87.5% (MitraClip), respectively. In 86.4% of the patients a residual MR grade \(\leq\) 1 + was achieved with PASCAL whereas reduction to MR grade \(\leq\) 1 + with MitraClip was achieved in 62.5%. Neither procedure time number of implanted devices, nor transmitral gradient differed significantly. No periprocedural MAE according to MVARC occured. \(\bf Conclusion\) In this highly selected patient group with complex PMR both systems exhibited equal procedural safety. MitraClip and PASCAL reduced qualitative and semi-quantitative parameters of MR to an at least comparable extent.