Myval transcatheter heart valve system: a new TAVI contender and remaining uncertainties

Transcatheter aortic valve implantation (TAVI) has evolved into a transformative alternative to surgical aortic valve replacement (SAVR), supported by robust evidence from numerous randomised clinical trials across the spectrum of surgical risk, and features two landmark transcatheter heart valve (THV) devices: the balloon-expandable SAPIEN (Edwards Lifesciences) and the self-expanding CoreValve/Evolut (Medtronic) series. Against this solid evidence base, novel THV technologies are increasingly tested in head-to-head comparisons against these established balloon-expandable and self-expanding valve standards of care (Figure 1)12345. In the recently published LANDMARK trial, a novel balloon-expandable prosthesis, the Myval THV (Meril Life Sciences), was directly compared with contemporary THVs (SAPIEN and Evolut series)4. Of note, the Myval THV introduces a sizing strategy with 1.5 mm diameter increments between nominal device sizes, allowing for a more nuanced sizing strategy to match the aortic annulus compared to conventional devices with fixed 3.0 mm diameter increments. Out of 5,109 screened patients, 768 patients deemed eligible for all three devices were randomly assigned 1:1 to Myval (N=384) or to contemporary THVs (N=384) with subsequent stratification...