Distinct designs, complementary strategies: Tendyne and SAPIEN M3 in transcatheter mitral valve replacement

Transcatheter mitral valve replacement (TMVR) has emerged as a transcatheter treatment option for selected patients with mitral regurgitation (MR) who are unsuitable for surgery or transcatheter edge-to-edge repair. Among dedicated TMVR devices, the Tendyne and SAPIEN M3 systems are the two clinically approved tech platforms with CE Mark and FDA approval. We comprehensively dissect their distinct design features, procedural characteristics, clinical outcomes, and associated complication profiles. Furthermore, we evaluate their respective patient selection criteria and long-term prognostic implications to facilitate evidence-based clinical decision-making for patients with severe MR. Beyond current metallic prostheses, this review extends to the future horizons of TMVR, specifically highlighting the emerging paradigm of tissue-engineered valvular stents and biodegradable scaffolds as potential solutions to overcome current limitations in prosthetic durability and biocompatibility.