Expanding indications for balloon-expandable transcatheter heart valves: Myval series in non-aortic and complex valvular disease

BACKGROUND: Transcatheter valve interventions are more frequently performed in complex anatomical cases, where standard device sizing can lead to procedural compromises. This review focuses on the Myval transcatheter heart valve (THV) system, which offers a distinctive granular sizing matrix with intermediate and extra-large options, designed to address the restrictions of conventional sizing.METHODS: Databases searched included MEDLINE (PubMed), Scopus, and the Cochrane Library. The research considered studies published in English up to January 2026 and was conducted using the following search query: (((“Myval”) OR (“Myval THV”)) AND ((((((“Aortic Valve Stenosis” [MeSH Terms]) OR (“Bicuspid Aortic Valve” [MeSH Terms])) OR (“Aortic Valve Insufficiency” [MeSH Terms])) OR ((“Mitral Valve” [MeSH Terms]) OR (“Tricuspid Valve” [MeSH Terms]))) OR ((“Pulmonary Valve” [MeSH Terms]) OR (“Right Ventricular Outflow Tract”))) OR ((“Valve-in-Valve”) OR (“Valve-in-Ring”)))).RESULTS: The availability of large and intermediate sizes allows for optimized patient treatment in complex valvular anatomies, mitigating procedural risks while ensuring good hemodynamic results. Furthermore, the use of Myval THV in failed mitral and tricuspid surgical bioprostheses and rings demonstrates high technical success, particularly in challenging valve-in-rings scenarios involving large surgical rings.CONCLUSIONS: The Myval THV extends the therapeutic use of balloon-expandable technology, providing a versatile tool for anatomy-driven device selection. While early outcomes in complex and off-label indications are promising, dedicated prospective studies and long-term follow-up are essential to fully define its durability and its comparative role against established standards of care.