Well, as an electrophysiologist referring patients for TAVR and seeing patients after TAVR, it seems like the Edwards sapien valve is the most popular among my interventionists. This has to do with physical factors determined pre-op. There are situations where the Medtronic valve is preferred, although I am not sure what these criteria are. I do notice that them Medtronic valve seems to be the only one that I have seen with late conduction system issues (>48 hours from the procedure), perhaps because it is self-expanding; but the overall incidence of heart block is progressively decreasing.

I would say Edwards Sapien 3 is our most commonly implanted valve given data and outcomes. The structural team does the decision making re specific valve implant.

The majority of my patients are receiving an Edwards sapien 3 valve. The Edwards valve has the most long term data. The improvements have allowed increased confidence in the long term results. Also easier access to the coronary arteries for future PCI. The changes in the skirt have allowed for better fit with less paravavular leak. Also less need for permanent pacemakers.

The majority of our procedures are with the Edwards S3 valve. Its track record, profile, and familiarity are some reasons why it’s the primary choice. For patients who have certain anatomical features, the Medtronic valve is preferred. I’m excited to see the continued evolution in valve technology over time as well as new applications in the future such as use in aortic regurgitation.

My first choice for TAVR is the Edwards Sapien 3 valve due to the extensive clinical data and proven safety and outcomes with this valve. Also, the valve comes in many different sizes depending on the patient’s aortic root diameter and typically allows access to the coronary arteries. Valve technology is continually evolving and physicians need to adapt to new valves as they become available.

Evolving valves and indications and SVD data all promising.

The Edward Sapien bio prosthesis is safe and has good efficacy. My patients have done well with it. There is good clinical data. Access to the coronary arteries is also less problematic as is necessary.

At this point in time I think the Edwards Sapien 3 valve has the edge, but as in all things, competing, motivated companies will innovate and leapfrog existing options. As a noninvasive cardiologist, I put my efforts mainly toward patient identification and education, refer those appropriate candidates to the structural/interventionist or a multifaceted Heart Team to time the procedure optimally and select the optimal valve for that patient in the toolbox extant.

Agree with comments so far -- TAVR keeps getting better and the companies that make the device safer with easier less effort implants that allow for repositioning, coronary access, and less complication rates will always win. We favor the Edwards line for many of these reasons.

Edwards Sapien Valve 3 would be the first choice. Need to take into account the need to access coronaries in the future if the need arises and also for valve in valve situations

The best choice of TAVR will always be a moving target, with one company leapfrogging the other with new devices. Eventually, as the technology matures the advances become more trivial. Ideally an institution should have devices from several companies. This may be limited by contractual issues, and availability of clinical trials. In general, I defer the choice of TAVR to the structural team who should be aware of the most recent iteration of each company's product

Anthony Spera MD
Nov. 29,2023

The valve of first choice is usually the Edwards SAPIEN 3 valve. The investigators in the PARTNER 3 Trial (New England Journal of Medicine, May 2, 2019) concluded that among patients with severe aortic stenosis who were at low surgical risk, the rate of the composite of death, stroke, or re-hospitalization at 1 year was significantly lower with TAVR (utilizing an Edwards SAPIEN 3 valve) than with surgery. Patients will also regain their independence quicker.

Edwards has been a long time champion of the TAVR family and this has been mostly used in our institution. That being said, I do not have a specific favorite of the valve types as this is most deferred to the implanters. From my experience, the most important thing I can do is to offer the right patient a timely TAVR referral; so recognizing severe AS and connecting it to their symptoms is most crucial for me. More and more, I am sending younger patients to the TAVR clinic where they can receive the expert care that is being provided.

Edwards SAPIEN. Has good clinical outcomes with excellent post procedure coronary access, convenient sizes,, durability and nil to none paravalvular leakage.

Edward valve would be the valve of choice. It has less chance of calcification, better coronary access , less paravalvular leak and ability to implant pacemakers.

I think that for the majority of patients, about 80%, either valve would be fine. There is a tail on either side where patients are suited for one valve or the other. Some are at risk for patient prosthesis mismatch where a Medtronic valve would be beneficial. Due to coronary access issues and heights, there are certain situations where SAPIEN is better. Our institutional preference has been to use Edwards valves, but that is generally because of historical contracting and clinical trial arrangements.

My First choice of valve for TAVR is EVOLUT family, it has wide range of annular sizes, ability to recapture and reposition when it is less than 80% deployed, good durability data, extensive evidence base, is a self expanding device that fixes to the annulus without use of calcium by engaging the native aortic cusps through an active clipping mechanism.
A systemic review demonstrated coronary obstruction is more common after TAVI with a balloon- expandable valve then a self-expanding valve, a finding corroborated by a subsequent multicenter registry. The inability to reposition or retrieve makes the Sapien family of balloon expandable valves an unattractive choice in patients at high risk of coronary obstruction.

would concur that Edwards valve is valve of first choice due to better access to coronaries for possible future interventions, and enhanced anticalcification. In younger patients the initial procedure can be TAVR with second procedure a SAVR with bioprosthesis and third procedure VIV TAVR if required..

While originally designed for patients with severe aortic stenosis (AS) considered inoperable, TAVR is now performed in younger and lower-risk patients, regardless of surgical risk. Ongoing design improvement has resulted in reduced paravalvular leak (PVL) and conduction disturbances, and smaller profile of delivery systems with enhanced procedural maneuvarability causes minimal vascular complications and bleeding.
While I really like the advances in Evolut FX platform, I would say my first choice for TAVR would be the 5th generation Sapien X4 THV platform which has been redesigned for lifetime management of AS. Some of the improvements are 1) Enhanced anticalcification technology with the RESILIA tissue platform, 2) 3 available THV sizes (23, 26, and 29 mm, with 16 unique deployment diameters in increments), 3) Enhanced polyethylene (PET) outer skirt designed to minimize PVL while maintaining low profile access. 4) All this improvement is still going to be available in a 14/16F expandable sheath.
This concept is being tested in the ALLIANCE study (ongoing) assessing the safety/efficacy of the new SAPIEN X4 in a broad patient population, including any surgical risk level, bicuspid anatomy, and valve-in-valve patients.

The index procedure defines the long term outcomes of the patient. The access to coronaries,pacemaker implantation and the second calve are predicated by the index valve.