Current and future transcatheter aortic valve replacement valves

Abstract

Purpose of reviewThis review analyzes currently available commercial transcatheter aortic valve replacement (TAVR) valves as well as valves in investigational status and those in preclinical testing. The design features and clinical outcomes of the Edwards SAPIEN S3 and Medtronic Evolut PROþ are described and compared with highlight clinical circumstances where one may be favoured over the other. Recent findingsMultiple randomized and nonrandomized trials have compared commercial and investigational TAVR valves. The results of these are summarized and discussed within this review with a focus on how the SAPIEN S3 and Evolut PROþ both compare to each other as well as various valves in different investigational stages. SummaryTAVR is an innovative and ground-breaking technology that will forever have revolutionized the management of aortic stenosis. Though the technology and valves themselves have come a long way, further developments are necessary if we are to continue to expand its indications and achieve a safer perioperative experience with more durable valves.

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“…The Evolut SE valve consists of a nitinol frame with a supra-annular porcine tissue valve [ 27 ]. The Evolut Pro has an added external porcine pericardial wrap in contrast to the Evolut R. This external wrap is located at the lower end of the frame and serves to increase surface contact with the native anatomy in order to lower the risk for PVL.…”

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“…However, as this technology matures and advances, more devices are and will be coming to market, increasing the cardiac surgeons’ armamentarium. 8 …”

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“…Additionally, the new version of the valve is one of the few commercially available TAVI system that can treat even larger annulus ranged up to 30 mm diameter. Finally, a last advantage is the miniaturization of the delivery system for access down to 5.0 mm vessels with 23-29 mm valves [23]. Of note, the latest member of the Evolute family, the Evolute FX valve has been recently developed, and designed to provide greater precision and control throughout the procedure, making the system easier to use with enhanced visualization capabilities for orientation and dept [24].…”