A retrospective single-center study at a high-volume tertiary center evaluated 366 consecutive patients with moderate-to-severe or severe mitral regurgitation treated with transcatheter edge-to-edge repair between 2019 and 2024. Patients received PASCAL-ACE (n=128) or PASCAL (n=238); mean age was 77.7±10.2 years and 57.9% were male. PASCAL-ACE was preferentially used for more complex mitral anatomies and had a larger baseline three-dimensional mitral valve orifice area (6.55 vs 5.87 cm²; P=.001).

Relative orifice-area reduction after the first device was similar (−44.5±6.55% vs −45.9±6.61%; P=.066) across functional, degenerative, and mixed mitral regurgitation subgroups (all P>.05). PASCAL-ACE had a smaller mean pressure-gradient increase (+1 [0–1] vs +1 [1–2] mmHg; P=.046), likely reflecting a larger residual orifice area (3.81±1.11 vs 3.38±1.07 cm²; P<.001). Annular sphericity was…