Sinem Özbay ÖZYILMAZ, Enes ALIÇ, Ahmet HURAİBAT, Mehdi ONAÇ, Mohamed NIANG, Teoman KILIÇ, Hakan UÇAR
Interventional Cardiology Perspectives - 2026;2(2):33-39
Background: The PASCAL transcatheter edge-to-edge repair (TEER) system was developed for patients with symptomatic severe mitral regurgitation (MR), particularly those at high surgical risk. However, real-world experience with this system remains limited. Aim: To report procedural success, in-hospital events, and discharge echocardiographic findings from the first Turkish case series of patients treated with the PASCAL system. Study Design: Retrospective study. Methods: We retrospectively reviewed consecutive patients who underwent PASCAL-based TEER at a tertiary care center between January 2023 and October 2025. Clinical, procedural, and echocardiographic data were analyzed. Results: Twenty-three patients underwent PASCAL-based TEER, with 35 devices implanted (11 P10 and 24 advanced closure and enhancement). Procedural success was achieved in all patients according to the prespecified definition. The patient with single-leaflet device attachment had residual MR <=2+ at discharge and did not require urgent surgery; therefore, the procedure met the predefined success criteria. Two periprocedural complications occurred: one case of single-leaflet device attachment and one episode of decompensated heart failure. No in-hospital deaths occurred. Procedure duration was longer in patients with fibrotic or lipomatous interatrial septal morphology than in those with a normal interatrial septum (118 vs. 53 minutes; p=0.001). Postprocedural pulmonary venous S>D flow was observed in 21 patients (91%). The mitral valve area decreased from 5.13 cm² to 3.70 cm², and the three-dimensional vena contracta area decreased from 0.63 to 0.18 cm² (both p<0.001). Transmitral gradients increased modestly without clinically significant mitral stenosis. Conclusion: In this small retrospective series, PASCAL-based TEER was technically feasible and was associated with favorable discharge echocardiographic findings. No in-hospital deaths occurred. These findings are preliminary and should be interpreted with caution.
