Novel transcatheter aortic valve replacement devices

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis (AS), offering a less-invasive alternative to surgical aortic valve replacement.Since its approval in the United States in 2011 for patients with severe AS at high or extreme surgical risk, TAVR has undergone continuous advancements.Early-generation TAVR devices prioritized reducing periprocedural complications like paravalvular leak, stroke, and major vascular complications.These complications have become increasingly uncommon due to iterative improvements in device design.Today, TAVR is an established treatment across the entire risk spectrum for patients with AS.Because significant progress has been made, the focus of technological innovation has shifted to addressing long-term issues.These include optimizing valve hemodynamics, mitigating structural valve deterioration, ensuring ease of coronary access and intervention, and enhancing the feasibility of future TAVR-in-TAVR procedures-collectively referred to as the lifetime management of patients with AS.This article provides a comprehensive review of the latest TAVR platforms approved or under investigation in the United States.It highlights the design features that enhance the safety and efficacy of established transcatheter heart valves (THV) and explores emerging platforms and adjunctive technologies poised to shape the future of TAVR in the United States. COMMERCIALLY AVAILABLE TAVR PLATFORMS IN THE UNITED STATESThe rapidly expanding indications for TAVR underscore the need for devices capable of addressing diverse patient populations and complex anatomical variations.Currently, 3 valve platforms approved by the Food and Drug Administration (FDA) are available for commercial use in the United States for TAVR in patients with severe AS.These platforms, along with their iterations, aim to enhance valve delivery and deployment, improve coronary access, reduce the incidence of paravalvular leak and pacemaker implantation, and expand the range valve sizes.The design of these valves and their subsequent iterations are shown in Figure 1.The characteristics of commercially available and investigational aortic THV are shown in Table 1.