Myval Beyond the Aortic Valve: Device–Anatomy Interaction, Procedural Strategy, and Clinical Evidence in Mitral, Tricuspid, and Pulmonary Positions

Figures

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  Figure 1. Position-specific device–landing-zone interactions during non-aortic Myval implantation. (A) Mitral applications include valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification, requiring assessment of anchoring, landing-zone geometry, and neo-left ventricular outflow tract obstruction. (B) Tricuspid implantation requires evaluation of prosthesis or ring geometry, venous trajectory, device-lead interaction, and right-ventricular function. (C) Pulmonary implantation requires assessment of right ventricular outflow tract geometry, distensibility, and coronary-compression risk. Intermediate sizes increase nominal sizing granularity, but their effect on anchoring, sealing, residual gradients, and clinical outcomes has not been established; deployment is non-recapturable. All applications are off-label and supported predominantly by observational evidence. Abbreviations: AML, anterior mitral leaflet; CIED, cardiac implantable electronic device; ID, internal diameter; LVOT, left ventricular outflow tract; MViR, mitral valve-in-ring; MViV, mitral valve-in-valve; neo-LVOT, predicted residual left ventricular outflow tract after transcatheter mitral valve replacement; RV,…

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  Figure 2. Evolution of the Myval balloon-expandable transcatheter heart valve platform. The figure compares the first-generation Myval, Myval Octacor, and Myval Octapro with respect to frame architecture, sealing components, delivery system, and reported deployment foreshortening. All three platforms retain an intra-annular trileaflet bovine pericardial valve and the nine-diameter 20–32 mm size matrix. The custom-manufactured nominal 35 mm Myval derivative is identified separately because it lies outside the routine platform and should not be regarded as a distinct commercial generation. Device photographs are displayed in the expanded configuration and at similar visual height; prosthesis diameters are not shown to scale. The figure illustrates design evolution and does not imply comparative clinical superiority. Images reproduced with permission from Meril Life Sciences.

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  Figure 3. Anatomy-first Heart Team algorithm for non-aortic Myval implantation. Multimodality imaging and, when indicated, balloon interrogation are integrated to assess landing-zone geometry, anchoring, sealing, access trajectory, and interaction with adjacent structures. The framework represents a synthesis of published evidence and expert opinion and has not been prospectively validated. Myval-specific evidence is lacking for the sequence and weighting of its branches, anchoring and sealing thresholds, sizing and platform selection, implantation depth, indications for adjunctive procedures, position-specific ventricular criteria, and post-implantation acceptance thresholds. It should not be interpreted as a clinical prediction rule or stand-alone treatment recommendation. All non-aortic Myval applications are off-label and jurisdiction-dependent. Abbreviations: AML, anterior mitral leaflet; CIED, cardiac implantable electronic device; CT, computed tomography; ID, internal diameter; LVOT, left ventricular outflow tract; MAC, mitral annular calcification; MViR, mitral valve-in-ring; MViV, mitral valve-in-valve; neo-LVOT, predicted residual left ventricular outflow tract after…