Mastering PASCAL in Complex Mitral Anatomy: Strategy, Technique, and Real-World Lessons: SWAC Nov 25

Complex mitral valve anatomy continues to challenge even the most experienced TEER operators. In this month's SWAC conference, Dr. Sergio Garcia, Dr. Tom Waggoner, Dr. Mark Bieniarz, and Dr. Aidan Raney walk through how to approach PASCAL therapy in anatomies where leaflet length, clefts, stenosis, and calcification make decision-making difficult.Using multiple real patient examples, they break down:• How PASCAL’s separatable clasps change strategy in short posterior leaflets• When to choose PASCAL vs Pascal Ace based on anatomy• Managing posterior leaflet restriction, clefts, and deep scallop gaps• How clasping technique differs from MitraClip• Imaging keys for procedural success on transesophageal echo• When to attempt independent clasping—and when not to• Avoiding iatrogenic mitral stenosis• What to do when coaptation depth is low or leaflet mobility is asymmetric• Real-world case outcomes, lessons, and clinical pearls from each scenarioA must-watch for operators training in PASCAL or managing anatomies that push TEER beyond standard degenerative or functional mitral regurgitation.Chapters:00:00 – Introduction: Why complex mitral anatomy requires a different strategy 01:00 – Case review overview and PASCAL system fundamentals 01:40 – Leaflet length, calcium, clefts: deciding if TEER is feasible 02:20 – When to choose PASCAL vs Pascal Ace 03:00 – Understanding PASCAL’s independent clasping advantage 03:40 – Case 1: Short posterior leaflet and how to secure a durable grasp 04:20 – Using TEE to confirm leaflet insertion and avoid chordal entanglement 04:50 – Maneuvering around a cleft and choosing the correct landing zone 05:20 – Case 2: Posterior leaflet restriction and reduced mobility 05:50 – Why independent clasping helps unequal coaptation 06:20 – Residual MR strategies: reposition, reclasp, or add a second device 06:50 – Case 3: When coaptation depth is too shallow for a central grasp 07:20 – Recognizing when stenosis risk outweighs TEER benefit 07:45 – Procedural adjustments when leaflet tissue is limited 08:10 – Case 4: Complex functional MR with tenting and asymmetric jets 08:45 – TEE markers for good versus poor grasping zones 09:10 – Post-grasp evaluation: gradients, residual jets, and stability 09:40 – Final thoughts: how PASCAL expands TEER into anatomies once avoided🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA#Mitr alValve #TEER #PASCAL #StructuralHeart #TAVR #HeartTeam #EchoGuidedProcedures #InterventionalCardiology #MitralRegurgitation #MurmurMD #SWAC