MItraClip Vs Pascal

[sevoflurane]

---

Members do not see this ad.

Curious if any of the structural guys here are switching to Pascal.
Pascal seems to be slightly more echogenic and crossing the septum seems more forgiving if you can't get 4.5 cm height for whatever reason. The ace variant seems to be a nice size, while the 10 seems to be quite large with resulting higher gradients (this is anecdotal based on 2 cases). I like how the Pascal edge to edge tends to not be as rigid as the MitraClip while maintaining a good tissue bridge.
We are exploring Pascal because we have found a few cases where the clip loosened up over time. Might just be a few outliers, but curious if anyone else is adopting Pascal over MitraClip or if there are specific situations you would choose one over the other.

 

[UscGhost]

Pedro?

I liked him in Game of Thrones, the Last of US and he did a good job on SNL

 

[thinkorswim]

Our cardiologists switched to Pascal. They seem to like it since it's less traumatic on the leaflets and the delivery system is more elegant.

I still think the procedure is dumb and hate them both equally.

 

[Bertelman]

We've got two groups doing clips. One uses primarily MitraClip, the other Pascal. So it's hard for a true comparison since the operators are also different. But I do feel as though the Pascal device gives a little more control of where to grasp the leaflets. And I like the grasping arms a little better. Definitely easier to confirm contact with grasping arms, which is super relevant once you're doing >1 clip.

 

[sevoflurane]

Our cardiologists switched to Pascal. They seem to like it since it's less traumatic on the leaflets and the delivery system is more elegant.

I still think the procedure is dumb and hate them both equally.

I find reduction of severe MR with coanda and reversal of flow in the pulmonary veins to trace MR and normalization of PVF highly satisfying in a patient who is not a candidate for surgical MVR. I also find the imaging very interesting compared to an AVR or CABG. The interaction btw/ cards/ct surg and ct anesthesia is highly interactive.

Right now MC/abbot have most of the market share, but seems like that may be changing. Edwards seems to be making some progress with Pascal. I believe SLDA is lower with Pascal. Abbot does offer more device options (xt, xtw, nt, ntw).

Will be interesting to see what happens over the next few years.

 

[urge]

Pascal seems better since it allows to grab each leaflet sequentially, instead of simultaneously like the MitraClip.

Those “loosened” clips most likely never grabbed the leaflet properly.

 

[PpfSuxTube]

Pascal seems better since it allows to grab each leaflet sequentially, instead of simultaneously like the MitraClip.

Those “loosened” clips most likely never grabbed the leaflet properly.

Our clips I've seen them close the gripper arms separately im fairly sure. In fact I think they always close them separately

Never done or even heard of a Pascal until now.
I find the whole procedure tedious and dont reallu like it but we've definitely had some great successes with it... we even offer a sort of emergency clip procedure for ischemic pap rupture and the like. N=3 survived to discharge.

They really need to figure out the next generation solution. Edge to edge repair i hope isn't the best perc option for tri/mitral.