Mitral Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Device Knobology and Review of Advanced Steering Maneuvers

Santiago Garcia; Sammy Elmariah; Robert J Cubeddu; Firas Zahr; Mackram F Eleid; Susheel K Kodali; Puvi Seshiah; Rahul Sharma; D Scott Lim

doi:10.1016/j.shj.2023.100234

Mitral Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Device Knobology and Review of Advanced Steering Maneuvers

Struct Heart. 2023 Nov 18;8(1):100234. doi: 10.1016/j.shj.2023.100234. eCollection 2024 Jan.

Authors

Santiago Garcia¹, Sammy Elmariah², Robert J Cubeddu³, Firas Zahr⁴, Mackram F Eleid⁵, Susheel K Kodali⁶, Puvi Seshiah¹, Rahul Sharma⁷, D Scott Lim⁸

Affiliations

¹ The Christ Hospital Health Network, Cincinnati, Ohio, USA.
² University of California, San Francisco, California, USA.
³ Naples Heart Institute, Naples, Florida, USA.
⁴ Oregon Health Sciences University, Portland, Oregon, USA.
⁵ Mayo Clinic, Rochester, Minnesota, USA.
⁶ Columbia University, New York, New York, USA.
⁷ Stanford University, Palo Alto, California, USA.
⁸ University of Virginia, Charlottesville, Virginia, USA.

Abstract

In 2022, the Food and Drug Administration approved a second mitral transcatheter edge-to-edge repair device for the treatment of primary mitral regurgitation (PASCAL Precision Transcatheter Valve Repair System, Edwards Lifesciences, Irvine, CA). The PASCAL Precision system consists of a guide sheath, implant system, and accessories. The implant system consists of a steerable catheter, an implant catheter, and the implant (PASCAL or PASCAL Ace). The guide sheath and steerable catheter move and flex independently from each other and are not keyed, allowing for freedom of rotation in three dimensions. This manuscript provides an overview of the PASCAL Precision system and describes the basic and advanced steering maneuvers to facilitate effective and safe mitral transcatheter edge-to-edge repair.

Keywords: Mitral regurgitation; Pascal implant; TEER.