Three-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study

• Published in: Catheterization and cardiovascular interventions Vol. 102; no. 1; pp. 145 - 154
• Main Authors: Spargias, Konstantinos, Lim, D Scott, Makkar, Raj, Kar, Saibal, Kipperman, Robert M, O Neill, William W, Ng, Martin K C, Smith, Robert L, Fam, Neil P, Rinaldi, Michael J, Raffel, Christopher O, Walters, Darren L, Levisay, Justin, Montorfano, Matteo, Latib, Azeem, Carroll, John D, Nickenig, Georg, Windecker, Stephan, Marcoff, Leo, Cohen, Gideon N, Schäfer, Ulrich, Webb, John G, Szerlip, Molly
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2023
• Subjects: Cardiac Surgical Procedures; Clinical trials; Congestive heart failure; Heart failure; Heart Valve Prosthesis Implantation; Humans; Mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Patients; Prospective Studies; Quality of life; Regurgitation; Survival; Treatment Outcome; Ventricle; DMR; TEER; FMR; mitral repair; CLASP; 3-year outcomes
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30686

Mitral valve transcatheter edge-to-edge repair (M-TEER) is an effective option for treatment of mitral regurgitation (MR). We previously reported favorable 2-year outcomes for the PASCAL transcatheter valve repair system. We report 3-year outcomes from the multinational, prospective, single-arm CLASP study with analysis by functional MR (FMR) and degenerative MR (DMR). Patients with core-lab determined MR ≥ 3+ were deemed candidates for M-TEER by the local heart team. Major adverse events were assessed by an independent clinical events committee to 1 year and by sites thereafter. Echocardiographic outcomes were evaluated by the core laboratory to 3 years. The study enrolled 124 patients, 69% FMR; 31% DMR (60% NYHA class III-IVa, 100% MR ≥ 3+). The 3-year Kaplan-Meier estimate for survival was 75% (66% FMR; 92% DMR) and freedom from heart failure hospitalization (HFH) was 73% (64% FMR; 91% DMR), with 85% reduction in annualized HFH rate (81% FMR; 96% DMR) (p < 0.001). MR ≤ 2+ was achieved and maintained in 93% of patients (93% FMR; 94% DMR) and MR ≤ 1+ in 70% of patients (71% FMR; 67% DMR) (p < 0.001). The mean left ventricular end-diastolic volume (181 mL at baseline) decreased progressively by 28 mL [p < 0.001]. NYHA class I/II was achieved in 89% of patients (p < 0.001). The 3-year results from the CLASP study demonstrated favorable and durable outcomes with the PASCAL transcatheter valve repair system in patients with clinically significant MR. These results add to the growing body of evidence establishing the PASCAL system as a valuable therapy for patients with significant symptomatic MR.