Valves in the Cath Lab – 2025 Update article with TAVR, TCMV, Tricuspid, and now Pulmonary valve sections.
Valves in the Cath Lab – 2025 Update article with TAVR, TCMV, Tricuspid, and now Pulmonary valve sections.
“This report draws on medical news coverage from the American College of Cardiology (ACC) published between March and July 2025, reflecting major trial results, device approvals, and procedural advances in catheter-based heart valve treatments — including aortic, mitral, tricuspid, and pulmonary interventions.
Source: American College of Cardiology – Latest in Cardiology.”
Valves in the Cath Lab – 2025 Updates and Evolving Practices
Background :
Catheter-based heart valve therapies have transformed the field of structural heart disease, offering less invasive alternatives to surgery for patients with complex valve pathology. What began with pioneering work in the aortic position has now expanded to the mitral, tricuspid, and pulmonary valves, each with its own devices, challenges, and rapidly evolving evidence base.
1. TAVR – From High-Risk to Mainstream
Transcatheter Aortic Valve Replacement (TAVR) was first developed for patients with severe aortic stenosis who were not surgical candidates. Over the last decade, strong trial data have expanded its use to intermediate- and even selected low-risk patients. Delivered most often via the femoral artery, TAVR offers rapid recovery, high procedural success, and standardized approaches thanks to predictable aortic anatomy.
One ongoing concern is stroke risk during TAVR. Debris from calcified valve leaflets or the aorta can embolize to the brain. Cerebral embolic protection (CEP) devices, like the Sentinel filter, aim to capture this debris. However, the BHF PROTECT-TAVI trial (7,600+ patients, UK) presented at ACC 2025 and published in the New England Journal of Medicine showed no significant reduction in stroke rates with routine CEP use compared to TAVR without CEP. A meta-analysis combining PROTECT-TAVI with the earlier PROTECTED TAVR trial confirmed this, with only a non-significant trend toward fewer disabling strokes. Current guidance: avoid routine CEP use, reserving it for select high-risk patients, and focus on careful procedural technique.
2. TCMV – The Next Frontier
Transcatheter Mitral Valve (TCMV) therapy encompasses multiple approaches, including Transcatheter Mitral Valve Repair (TMVr) with devices like MitraClip (Abbott) and Pascal (Edwards), and Transcatheter Mitral Valve Replacement (TMVR) systems such as Tendyne and Intrepid.
Unlike the aortic valve, the mitral valve has a complex, saddle-shaped anatomy, tethered by chordae tendineae and surrounded by dynamic structures. This complexity makes catheter-based repair and replacement more challenging. While mitral TEER is now widely performed for selected patients with primary or secondary mitral regurgitation, TMVR is still in earlier stages, with ongoing device refinement and patient selection research.
3. Tricuspid Valve – The ‘Forgotten’ Valve in Focus
The tricuspid valve has historically been neglected, but recognition of tricuspid regurgitation (TR) as a cause of morbidity has grown. Many TR patients are elderly, frail, and high-risk for surgery. Recent innovations now offer percutaneous options:
• TriClip (Abbott) – Transcatheter Edge-to-Edge Repair (T-TEER) adapted from MitraClip technology.
• Evoque (Edwards Lifesciences) – The first FDA-approved Transcatheter Tricuspid Valve Replacement (TTVR) system.
A major milestone came in July 2025 when CMS approved national Medicare coverage for TriClip T-TEER, following earlier approval for Evoque TTVR. This will likely accelerate adoption and encourage private insurers to follow.
TriClip is safe and effective, but technically demanding — often more complex than mitral TEER due to valve anatomy and imaging challenges. Expansion will require specialized operator training. Experts stress that not all TR patients need intervention; optimal medical therapy, especially diuretics, should be tried before referral.
4. Pulmonary Valve – Expanding Transcatheter Options
Transcatheter Pulmonary Valve Replacement (TPVR) is a critical tool in managing right ventricular outflow tract (RVOT) dysfunction, common in patients with congenital heart disease after prior surgeries.
Key devices:
• Melody™️ (Medtronic): Balloon-expandable valve for dysfunctional RV-PA conduits or surgical bioprostheses; long-term data support its durability.
• Harmony™️ (Medtronic): Self-expanding valve for native or surgically repaired RVOT with severe pulmonary regurgitation; FDA-approved in 2021.
• SAPIEN 3 + Alterra™️ (Edwards): Balloon-expandable valve implanted within an adaptive prestent to create a landing zone in large RVOT anatomies; approved for both pediatric and adult severe PR cases.
TPVR offers shorter recovery times and can be repeated during a patient’s lifetime, making it particularly valuable in congenital heart disease care. Programs need congenital imaging expertise for precise sizing and placement.
Risks include endocarditis, underscoring the need for careful follow-up with imaging and functional assessment. Ongoing post-approval studies aim to refine device use and confirm long-term outcomes.
Looking Ahead:
Catheter-based valve therapies are moving toward more personalized, anatomy-specific solutions:
• TAVR is now standard for severe aortic stenosis in most surgical risk categories, with focus shifting to stroke prevention strategies and long-term valve durability.
• Mitral interventions are expanding but require continued innovation to address complex anatomy and broaden eligibility.
• Tricuspid therapy has entered a growth phase thanks to device availability and reimbursement policy changes, but operator training and patient selection remain key.
• Pulmonary TPVR continues to expand in congenital care, offering durable, repeatable solutions without open surgery.
The future of valve care in the cath lab lies in integrating advanced device technology, high-quality imaging, multidisciplinary decision-making, and data-driven patient selection to ensure safe, effective, and lasting results for patients across all four heart valves.
