Tricuspid Regurgitation: Edge-to-Edge Treatment with PASCAL

About 4% of the population suffers from tricuspid regurgitation (TR). This disease is associated with hard-to-manage heart failure (HF)—often requiring hospitalization—and with mortality.

ATC sobre arterias nativas o puentes venosos, ¿cuál tiene mejor pronóstico?

Surgery in this valve is not simple and has high morbidity and mortality rates due to its comorbidities.

Currently, a percutaneous strategy for its resolution is under development, but we still do not have solid evidence to know its real benefit.

The PASTE registry (PASCAL for Tricuspid Regurgitation – A European Registry) included 235 patients with TR and high risk for surgery.

The chosen devices were PASCAL and PASCAL Ace.

Mean patient age was 78 years old, and 51% of subjects were male. Ninety-two percent had atrial fibrillation, 2% had undergone tricuspid valve surgery, 11% had undergone myocardial revascularization surgery (MCRS), 7% had had aortic valve replacement, 2% had undergone renal transplantation, and 92% had impaired renal function. The functional class for most patients was III-IV, 13% had ascites, one third had an implantable cardioverter-defibrillator (ICDD), and practically all of them were on diuretic drugs.

Read also: Changes in Coronary Collateral Function Post CTO Intervention.

Their Society of Thoracic Surgeons (STS) score was 8.6%. 

Eighty-seven percent of the TRs were functional, 91% were severe, massive or torrential; on average, the effective regurgitant orifice was 0.65 mm; the left atrial area was 39 mm; the right ventricular end-diastolic diameter was 54 mm; the inferior vena cava diameter was 24 mm; the pulmonary artery systolic pressure was 46 mmHg and their mean pressure was 29 mmHg.

Technical success was 98%, and in 78% of patients the reduction in TR was ≤2+. The number of devices implanted per patient was 1.7: 66% were implanted at the antero-septal level, and the gradient at discharge was 2.2 mmHg. Only one patient required surgery and six experienced device disconnection from one of the leaflets. Success rate for patients with ICDD was 98%.

Read also: TRICVALVE in Patients with Severe Tricuspid Regurgitation: Promising Results at 6 months.

Mortality at 30 days was 1.6%.

At the 6-month follow-up, the rate for mortality was 12%, for rehospitalization for HF was 13%, and the average for HF hospitalization since the index procedure was 105 days.

There was a significant improvement in the functional class and the quality of life, as well as in the results of the 6-minute walk test.

In addition, there was a significant reduction in right ventricular end-diastolic diameter in the right atrium area and inferior vena cava, and a reduction in TR ≤2+ in 78% of patients.

There was no difference in the results between the PASCAL and PASCAL Ace devices.

Conclusion

In this initial experience, the PASCAL and PASCAL Ace devices had high technical and procedural success rates, with efficient reduction of tricuspid regurgitation. They also showed significant clinical and echocardiographic improvement at follow-up.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Multicenter Experience With the Transcatheter Leaflet Repair System for Symptomatic Tricuspid Regurgitation.

Reference: Mirjam G. Wild, et al. J Am Coll Cardiol Intv 2022;15:1352–1363.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...