Myval Octacor: Innovative Design, Early Hemodynamic Gains, and Future Outlook

I read with great interest the article by Moscarella et al. comparing the balloon-expandable Myval Octacor valve with the self-expanding Evolut PRO/PRO+ and Acurate Neo2 devices [1]. I commend the authors for this timely analysis, as TAVI is increasingly being performed in younger, lower-risk patients who not only require optimal immediate outcomes but are also likely to need repeat interventions over their lifetime. The propensity-matched data provide valuable short-term outcomes for the novel Octacor in symptomatic severe aortic stenosis. Notably, Myval Octacor achieved a higher 30-day device success rate than the self-expanding valves (97% vs. 88%, p = 0.024), driven by a numerically lower incidence of moderate paravalvular leak (1% vs. 7%). Octacor also demonstrated superior hemodynamics, with a larger indexed effective orifice area, while 30-day rates of mortality, stroke, and permanent pacemaker implantation (PPI) were not significantly different between groups. These results indicate that Octacor's design enhancements translate into clinical benefit without compromising safety. This study complements the LANDMARK randomized trial, which showed noninferiority of the Myval transcatheter heart valve series versus Sapien 3 and Evolut valves at 30 days [2], although only ~4% of Myval implants in that trial were the new Octacor generation. Several design features of Myval Octacor likely underlie its favorable performance. The frame employs two rows of interlaced octagonal cells to reduce foreshortening and improve deployment accuracy. It retains a relatively short frame height and large open cells in the outflow zone to preserve coronary ostia access for future interventions. The external skirt extends over approximately half the height of the valve frame, enhancing sealing and reducing the risk of paravalvular leak. Despite intra-annular leaflet positioning, Octacor achieves a larger effective orifice area comparable to supra-annular valves [1]. The device is available in a broad range of sizes (20–32 mm, including intermediate diameters), allowing tailored sizing without excessive oversizing [3]. Its delivery system is streamlined—all sizes utilize a single 14-Fr expandable sheath, and the valve can be retrieved before deployment if repositioning is needed [4]. Moreover, the “OctaAlign” technique permits commissural alignment during crimping [5], optimizing coronary orientation and facilitating access in future valve-in-valve procedures [5]. Collectively, these innovations make Octacor well-suited for treating younger TAVI patients in whom lifetime management is a key consideration. We note that the observed PPI rate in the Octacor cohort (~15%) was higher than anticipated. The retrospective registry design and patient selection (e.g., baseline conduction disturbances) likely contributed to this finding. Indeed, other studies have reported low pacemaker requirements with Myval valves [3]. We concur with the authors that larger prospective studies with longer follow-up are warranted to validate these findings and confirm the long-term durability of Myval Octacor. At present, the MyVal platform is not approved for use in the United States. In Canada, it is available only through special access authorization, and our team had the distinction of performing the first MyVal implantation in the country. In summary, Moscarella et al. have provided important early evidence that the Myval Octacor can match or exceed contemporary transcatheter valves in short-term outcomes, while offering design advantages that will be increasingly relevant as TAVI expands to low-risk populations who may ultimately require valve-in-valve treatment. The author declares no conflicts of interest.