2 October, 2026
PASCAL vs MitraClip in India: Which TEER Device Suits Your Mitral Valve?
You may already know about MitraClip. Now your doctor mentions PASCAL. Which one is right for your leaking mitral valve? The honest answer: it depends on your valve, not on the brand.
This guide explains PASCAL vs MitraClip in India – how each TEER device works, how they differ, and why experience matters more than the device name. It draws on the expertise of Dr A B Gopalamurugan, Chennai-based interventional cardiologist and a pioneer of transcatheter mitral, tricuspid and TAVR/TAVI therapies in India.
First, What Is TEER?
Transcatheter Edge-to-Edge Repair (TEER) treats mitral regurgitation – a leak in the mitral valve – without open-heart surgery. A device is passed through the groin vein into the heart and attaches the two mitral leaflets together where the leak occurs. Both MitraClip (Abbott) and PASCAL (Edwards Lifesciences) are TEER devices.
New to TEER? Start with our guide: MitraClip & TEER in India.
PASCAL vs MitraClip: Device Concept
MitraClip
- The original and most widely used TEER device worldwide, with long-term data
- Uses two clip arms and grippers to capture the leaflets
- Available in multiple sizes (narrow and wide, standard and extended arms) to match different anatomies
- Latest generation allows independent grasping of each leaflet
PASCAL
- Uses broad, contoured paddles and clasps made of flexible nitinol
- Includes a central spacer that fills the gap between leaflets
- Allows independent leaflet capture and can be elongated to move smoothly through the valve’s chords
- Available as PASCAL and the narrower PASCAL Ace, delivered with the PASCAL Precision system
Side-by-Side Comparison
| Feature | MitraClip | PASCAL |
|---|---|---|
| Manufacturer | Abbott | Edwards Lifesciences |
| Leaflet grasping | Arms and grippers; independent grasping in latest generation | Paddles and clasps; independent leaflet capture |
| Central spacer | No | Yes |
| Size options | Several widths and arm lengths | PASCAL and PASCAL Ace |
| Clinical evidence | Extensive, including EVEREST and COAPT trials | CLASP studies, including CLASP IID randomised trial vs MitraClip |
| Also used in tricuspid valve | TriClip (related system) | Yes, in selected patients |
Which Device May Be Suitable? It Comes Down to Anatomy
Choosing between PASCAL and MitraClip is a technical decision made on detailed 3D transoesophageal echocardiography (TEE). The Heart Team looks at:
- MR mechanism – degenerative (prolapse or flail leaflet) or functional (enlarged heart)
- Gap and flail width – larger gaps may benefit from a spacer or wider device
- Leaflet length and thickness – short or thick leaflets need careful device choice
- Calcification and clefts in the grasping zone
- Mitral valve area – to avoid narrowing (stenosis) after repair
- Chordal density – how easily the device can navigate under the valve
- Number of devices needed – some patients need more than one clip
In many patients, either device can work well. In others, one design has a clear technical advantage. And in some, TEER is not the right answer at all – which is when TMVR vs MitraClip becomes the key question.
Read more: Mitral TEER – Patient Selection Is Everything.
What Does the Evidence Say?
MitraClip has the longest track record, with landmark trials such as EVEREST and COAPT supporting its use in degenerative and functional MR respectively. PASCAL was directly compared with MitraClip in the CLASP IID randomised trial in high-risk patients with degenerative MR, where it met its goal of non-inferiority for safety and MR reduction.
The takeaway for patients: both are proven tools. Results depend most on correct patient selection, imaging quality and operator experience.
Why the Heart Team’s Experience Matters More Than the Device
A team that only uses one device may fit every patient to that device. A team with experience across all transcatheter valve therapies can choose freely – MitraClip, PASCAL, TMVR, valve-in-valve, TAVR/TAVI or surgery.
Dr A B Gopalamurugan is recognised as a pioneer of transcatheter valve therapy in India:
- India’s first transcatheter mitral valve implantation (2017), published in the Indian Heart Journal
- India’s first transcatheter tricuspid valve implantation (2016), published in the Indian Heart Journal
- First TAVI/TAVR in South India (2015)
- India’s first MitraClip after heart transplantation
- Three of the world’s first transcatheter valve procedures
- Has introduced the largest number of transcatheter valve therapies to India
- Founder and Course Director of India Valves, India’s largest transcatheter valve therapy course
- 16 years of UK training and consultant practice (MD London, MRCP, FRCP)
Patients with both mitral and tricuspid leaks can also be assessed for combined treatment – see Tricuspid Regurgitation Treatment in India.
Frequently Asked Questions: PASCAL vs MitraClip
Is PASCAL better than MitraClip?
Neither device is universally better. Both are transcatheter edge-to-edge repair (TEER) systems. In the randomised CLASP IID trial, PASCAL was shown to be non-inferior to MitraClip for degenerative mitral regurgitation in patients at high surgical risk. The better device is the one that fits the individual patient’s valve anatomy.
Is PASCAL available in India?
PASCAL and MitraClip are both used for TEER in India at experienced structural heart centres. Device availability and suitability are discussed during the Heart Team evaluation.
What is the main design difference between PASCAL and MitraClip?
PASCAL uses broad contoured paddles with a central spacer that fills the regurgitant gap. MitraClip uses arms and grippers in several sizes to bring the leaflets together. Both allow independent grasping of each leaflet in their latest versions.
Who decides which TEER device I receive?
An experienced Heart Team decides after detailed 3D transoesophageal echocardiography, reviewing the cause of the leak, leaflet length, gap size, calcium and valve area.
What happens if TEER is not suitable for me?
Alternatives include transcatheter mitral valve replacement (TMVR), mitral surgery or optimised medical therapy. A team experienced in all of these can recommend the best option.
Find Out Which TEER Option Suits You
If you have severe mitral regurgitation and want to know whether MitraClip, PASCAL or another option is right for you, book an expert Heart Team evaluation.
Book a consultation with Dr A B Gopalamurugan in Chennai:
📞 OP appointments: +91 91760 88898
✉️ secretary@gopalamurugan.com
📍 2nd Floor, 46 & 48, Masilamani Rd, Balaji Nagar, Royapettah, Chennai 600014
Contact us online
This article is for patient education only and is not a substitute for individual medical advice. MitraClip is a trademark of Abbott; PASCAL is a trademark of Edwards Lifesciences. Treatment decisions should be made with your cardiologist and Heart Team.
