Valvular HD: 2023 Structural Highlights

Focus on Valves:

• TAVI vs. SAVR: Long-term data showed mixed results. PARTNER 3 (Sapien 3 valve) benefits declined over time, while Evolut Low Risk (CoreValve, Evolut R/PRO) favoured TAVI. Experts advise caution in direct comparison.
• Aortic Regurgitation: The ALIGN-AR trial demonstrated the success of the Trilogy valve for moderate-to-severe AR, with improved symptoms and quality of life.
• Ross Procedure: Analysis showed excellent long-term survival (25 years) for patients undergoing the Ross procedure.
• Mitral Regurgitation: The CLASP IID trial showed similar outcomes for MitraClip and Pascal devices in high-risk patients with degenerative MR, with sustained improvements.
• Tricuspid Regurgitation: TRILUMINATE Pivotal trial showed significant TR reduction and quality-of-life improvements with TriClip TEER but no mortality or heart failure hospitalization reductions. Additional analyses provided further insights.
• TTVR: The TRISCEND II trial found that Evoque valve + therapy offered near-complete TR elimination and symptom improvements, which was hailed as a significant advancement.

Challenges and Future Directions:

• Lead Jailing: Electrophysiologists call for improved communication between fields to address potential damage to pacemaker/defibrillator leads during tricuspid interventions.
• Areas to hear more in 2024:

1. Long-term data from low-risk TAVI trials.
2. TTVR as an alternative treatment option for tricuspid valve disease.
3. Expanding M-TEER with multiple device options.
4. Artificial intelligence applications in structural heart interventions.
5. Novel devices and research, including TAVI-in-TAVI procedures.

Overall, 2023 was a pivotal year for structural heart disease, with advancements in valve interventions and promise for future innovation.