Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is a well-established treatment for patients with severe aortic stenosis and intermediate-to-high surgical risk. The increasing clinical experience along with technical and design iterations of transcatheter valve systems have contributed to reducing adverse events and improving clinical outcomes. AREAS COVERED: Overview of the latest generation transcatheter heart valves (THVs), focusing on early safety and efficacy outcomes. EXPERT COMMENTARY: Improvements in valve repositionability, reducing the size of valve delivery systems, and antiparavalvular leak iterations have contributed to improving the safety and clinical outcomes following TAVR. However, while certain complications like major vascular events and residual paravalvular leaks have significantly decreased with the arrival of newer generation THVs, no major changes in thromboembolic events (particularly stroke) have been observed, whereas other complications like conduction disturbances requiring pacemaker implantation have slightly increased over time. Also, no major progress on device retrievability has been observed in the last years. The expansion of TAVR toward the treatment of younger and lower risk patients, as well as newer indications (e.g. asymptomatic patients) will likely require an extra-effort involving additional device iterations and complementary therapies (e.g. embolic protection, newer vascular closure devices) to further improve safety and clinical outcomes.