Minimally Invasive Aortic Valve Replacement Options

Minimal Invasive Aortic Heart Surgery

Have you been diagnosed with Aortic valve stenosis and experiencing severe symptoms such as:

  • Shortness of breath
  • Fatigue
  • Swelling in your legs
  • Dizziness
  • Chest pain
  • Passing out
  • An unpleasant awareness of your heartbeat
  • Fainting episodes

If yes, your heart doctor might have advised a Transcatheter Aortic Valve Replacement (TAVR) procedure for you instead of an open heart surgery (OHS).

Or, you might be having another health condition, such as kidney or lung disease or diabetes, which would make open-heart valve replacement surgery risky for you. In this case as well, your doctor might advise Transcatheter Aortic Valve Replacement (TAVR) for your aortic stenosis.

Our review of available scientific research on the safety and efficacy of the various options leads us to conclude that patients recommended for aortic valve replacement should seek consultation with a surgeon or cardiologist who utilizes the Sapien 3 line of prosthetic aortic valves.

Sapien 3 has equivalent or superior outcomes compared with other contemporary TAVR valves used to treat aortic stenosis in patients at high surgical risk. This is according to meta-analyses of many randomized controlled trials (RCTs) and large nonrandomized research studies. Furthermore, other high quality research studies suggest Sapien 3 is a safer alternative to Open Surgical Aortic Valve Replacement in patients at low surgical risk.1,2,3

We’re here to help you have a more informed conversation with your doctor about the right Aortic Valve Replacement for you.

What is Minimally Invasive Aortic valve replacement?

A minimally invasive aortic valve replacement is a surgery to replace a poorly working aortic valve with an artificial valve. The aortic valve is one of the heart’s 4 valves. The valves help blood flow through the heart’s 4 chambers and out to your body normally. The surgery is called “minimally invasive” because it uses a smaller incision than a traditional open repair. This may lead to easier and faster recovery from surgery.

Quick Reviewer

Below is a quick review of the main factors used in comparing the various valve systems.

Valve Options for TAVRSapien 3 & Sapien 3 UltraSapien XTCoreValveEvolut REvolut ProEvolut Pro+PorticoAcurate neo & Acurate neo2
Age Group65-80 years65-80 years65-80 years65-80 years65-80 years65-80 years65-80 years65-80 years
FDA ApprovalYesYesYesYesYesYesYesNo for Acurate neo2
Risk of Bleeding, Stroke, PVL & DeathLess than OHSMore than Sapien 3 & Sapien 3 UltraMore than Sapien 3 valvesOverall: less PVL: Less than Sapien 3Less than Evolut RPVL: less Bleeding & Stroke: MoreSimilar to other valvesNeo: More Neo2:less
Need for Pacemaker ImplantationLess than other valves in the marketLess than Sapien 3 & Sapien 3 UltraMore than Sapien ValvesMore than Sapien ValvesLess than Evolut RLessSimilar to other valvesLess

TAVR is the latest advancement in the treatment options for aortic stenosis. Aortic valve stenosis is a heart disease in which the aortic valve of the heart thickens (calcifies) with age and becomes narrow. This leads to decreased blood flow from the heart, through to the aortic valve, and into the rest of the body.

Normally, the aortic valve keeps blood flowing out of your heart and into your aorta (the main artery in your body) without blood flowing backward into your heart.

In the developed world, aortic stenosis is the most prevalent form of valvular heart disease. It is strongly age-related, with a prevalence of only 0.2% among people in their 50s but 9.8% among people in their 80s.

Why is TAVR Preferred Over Open Heart Surgery (OHS)?

Graphic representation of the positioning of TAVR

Now to the main part! Aortic valve stenosis is a mechanical impairment in the functioning of the aortic valve. This means it cannot be managed by medications alone and requires an interventional procedure to fix or replace the valve.

For a long time, open-heart surgery (OHS) for the replacement of an aortic valve with a mechanical artificial valve has been the treatment of choice in patients both over and under 65 years of age. It is a highly invasive and risky procedure associated with increased complications and requires longer hospital stays and regular follow-up checkups.


With time, there has been a need for an alternative option for older patients (>65 years) who have severe aortic stenosis exhibiting signs and symptoms or those who are at high risk of complications from Surgical Aortic Valve Replacement (SAVR) due to advancing age, an underlying health condition, or suppressed immune system. And this is where transcatheter aortic valve replacement (TAVR) comes in!

Although TAVR is now the treatment of choice for high-risk patients in the older age group, studies are still underway to employ this procedure, as a first-line treatment option, for patients younger than 65 years of age. If you would like us to alert you when TAVR receives approval for patients under age 65, sign up here.

What Exactly Happens During a TAVR Procedure?

TAVR has revolutionized the treatment for aortic stenosis so more and more patients in the older age group are benefiting from it.

It is a minimally invasive procedure, requiring sedation as opposed to general anesthesia, in which a flexible tube (catheter) loaded with the prosthetic valve, made from cow or pig heart tissue, is inserted into a blood vessel in your groin or chest area and guided to your heart through repetitive X-ray images or echocardiogram. Once it reaches the location of your natural aortic valve, the new valve is positioned there correctly and is fixed into place.

The best part? For TAVR, there are a variety of options for bioprosthetic heart valves available in the market! And we are here to give you a comparison of such options so that when you visit your doctor, you can make an informed decision regarding the valve option that you would want to go for.
So, let’s begin!

What are Your Options for Transcatheter Heart Valve Systems

There are different FDA-approved market options for transcatheter heart valves. But before diving deep into each of them, it’s important to know when are these valves indicated for use and in which patients should these not be used.

Who are the transcatheter heart valves indicated for?

These valves are indicated for patients who:

  • Have severe aortic stenosis due to age-related calcification of the aortic valve and exhibit signs and symptoms of the disease
  • Are at high risk of complications from OHS due to other health conditions or advancing age
  • Experience failure of a previous surgical bioprosthetic valve

When should the transcatheter heart valves not be used?

  • The transcatheter heart valves are not indicated for patients who:
  • Are allergic to the material of the prosthetic valve—for example, Nitinol (titanium or nickel) in the case of the CoreValve series
  • Cannot tolerate blood-thinning medications
  • Have an active infection of the heart, like active bacterial endocarditis, or other active infections

Transcatheter Heart Valves for TAVR

Now, let’s look at some details of each individual transcatheter heart valve for TAVR.

Sapien 3 (third generation) valve

Sapien 3 Valve by Edwards
The Sapien 3 transcatheter heart valve by Edwards Lifesciences Corp is a third-generation bioprosthetic valve made from a cow’s heart tissue. It has succeeded the second-generation Sapien XT valve on the market.
After its implantation, the Sapien 3 is associated with a lower incidence of pacemaker implantation in follow-up visits as compared to other transcatheter heart valves.3 It also requires a shorter hospital stay following TAVR, mainly because it has greatly reduced the occurrence of paravalvular regurgitation (PVL) or leakage around the valve.

Paravalvular regurgitation

Paravalvular regurgitation or paravalvular leak is a common complication seen in heart valve transplantation procedures. It occurs due to a space left between the natural heart tissue and the new artificial valve. As a result, blood flows back into the heart chamber during pumping or there is turbulent blood flow.

Systematic reviews have also documented lower rates of bleeding, stroke, and death with Sapien 3 as compared to OHS.

The correct sizing and placement of the Sapien 3 valve are essential because once deployed, the valve cannot be repositioned. A surgeon who is very experienced with this particular valve is critical.

Sapien 3 User Reviews

Sapien 3 Ultra valve

The FDA-approved Sapien 3 Ultra valve is a structurally modified version of Sapien 3 valve.

It shows the same success rates as Sapien 3 but is associated with a reduced incidence of paravalvular regurgitation.

Sapien XT (second generation) valve

The FDA-approved Sapien XT transcatheter heart valve  by Edwards Lifesciences Corp is a second-generation valve.


It has exhibited lower incidences of pacemaker implantation as compared to the third-generation Sapien 3 valve.

Sapien XT valve is associated with higher rates of stroke, vascular complications, and paravalvular regurgitation.

Sapien XT User Reviews

CoreValve series

The CoreValve series (Medtronic, Minneapolis, MN) consists of the first-generation CoreValve, Evolut R, Evolut Pro, and Evolut Pro+ valves. These valves are self-expandable, meaning that once positioned in place, they expand on their own and do not require a catheter-mounted balloon for inflation. This makes precise placement easier and repositioning possible if required.


CoreValve was the first-generation self-expandable valve introduced by Medtronic.

Although self-expandable valves allow for correct placement and easier repositioning as compared to balloon-expandable valves, the CoreValve has been associated with increased incidence of paravalvular regurgitation, bleeding complications, and stroke.

CoreValve User Reviews

Evolut R

Unlike the Sapien series, Evolut R can be repositioned after the TAVR procedure and is associated with fewer vascular complications like bleeding, stroke, etc. Multiple systematic reviews have documented decreased incidences of paravalvular regurgitation with Evolut R than with Sapien 3 valve.

The use of Evolut R valve for TAVR has shown an increased rate of permanent pacemaker installation in the long term.

Evolut R User Reviews

Evolut Pro

Evolut R has been succeeded by Evolut Pro.

Some studies have shown that Evolut Pro valves offer significant improvement against paravalvular leak and higher rates of pacemaker implantation seen with Evolut R valves. However, more large-scale studies are still needed to confirm this.

Evolut Pro+

Evolut Pro+ is a further improvement in the self-expandable CoreValve Series.

It is associated with fewer pacemaker installations and less paravalvular leaks.

There is increased risk of vascular complications such as bleeding and stroke with Evolut Pro+ valve.

Portico valve

The FDA-approved Portico valve by Abbott is a self-expandable valve that is implanted using the Abbott’s FlexNav delivery system. The sleek design of the delivery system caters to patients with different structural sizes of their aortic valves and small vessels. Its flexibility allows it to work through the calcified valves and vessels easily. This delivery system also ensures precise placement of the Portico valve during TAVR.

The advantages of using Portico valves, especially the decreased risk of developing stroke after the TAVR procedure, are similar to those seen with other transcatheter aortic valves. However, in long-term follow-up, patients implanted with Portico valve show improved heart health and physical strength and mobility.

Portico Valve User Reviews

Accurate neo2 valve

The Boston Scientific Acurate neo2 is a modified version of the self-expandable Acurate neo valve. It has received the Conformite Europeenne (CE) Mark but has not yet been approved for sale in the USA by FDA.

The first-generation Acurate neo has been associated with increased incidences of stroke, paravalvular regurgitation, and kidney injury. Therefore, the Acurate neo2 has been developed to address all these issues and it has delivered excellent results in clinical trials. However, if you are residing in the USA, you will have to wait for some time before you can opt for this valve!

Accurate Neo2 User Reviews

Frequently Asked Questions

Can an aortic valve be replaced with minimally invasive surgery?

A minimally invasive aortic valve replacement is a surgery to replace a poorly working aortic valve with an artificial valve without the need for open heart surgery. The surgery is called minimally invasive because it uses a smaller cut (incision) than a traditional open repair.

What is the success rate of minimally invasive aortic valve replacement?

In the NIHR study, bioprosthetic valves appeared safe, and they were linked to average lifespans when matched to the population having surgery. Ten years after replacement, the great majority of people (94%) had a functioning valve. After 20 years, more valves had failed, with 48% of valves deteriorating.

What is the recovery time for minimally invasive aortic valve replacement?

Most heart procedures – even those that are called minimally invasive – require that the patient be under anesthesia for four to six hours and for the surgeon to cut through part or all of the patient’s breastbone. The recovery time after these surgeries is six to eight weeks to allow the bone to heal.

How long is hospital stay after minimally invasive heart surgery?

Once you are able, your care team will encourage you to move around as much as possible during your hospital stay. Most patients can expect a two to five-day hospital stay following minimally invasive heart surgery.

What is the average age for aortic valve replacement?

Average patient age was 53 to 92 years.

What can We Conclude From This?

There are many different FDA-approved transcatheter aortic valves available in the market for your TAVR procedure. Now that you have a general idea of these options, we hope you will be able to make a more informed decision together with your doctor.

To sum it up, no one valve is right for every patient, but the clinical studies suggest that the Sapien 3 series of valves has the most favorable profile at the time of this posting.

Selected References

  1. Boskovski MT, Gleason TG. Current therapeutic options in aortic stenosis. Circ Res. 2021;128(9):1398-1417. doi:10.1161/CIRCRESAHA.121.318040
  2. Medtronic. Transcatheter aortic heart valves – indications, safety, warnings. Accessed May 19, 2022.
  3. Yasgur BS, MA, LMSW. Transcatheter aortic valve replacement: Current and emerging approaches. The Cardiology Advisor. Published December 14, 2015. Accessed May 19, 2022.
  4. Htun NM, Webb JG. Evaluation of the Edwards SAPIEN 3 transcatheter valve for aortic stenosis. Expert Rev Med Devices. 2016;13(3):225-232. doi:10.1586/17434440.2016.1149288
  5. Nazif TM, Cahill TJ, Daniels D, et al. Real-world experience with the SAPIEN 3 ultra transcatheter heart valve: A propensity-matched analysis from the United States. Circ Cardiovasc Interv. 2021;14(9):e010543. doi:10.1161/CIRCINTERVENTIONS.121.010543
  6. Alperi, A, Faroux, L, Muntané-Carol, G, and Rodés-Cabau, J. Meta-analysis Comparing Early Outcomes Following Transcatheter Aortic Valve Implantation With the Evolut Versus Sapien 3 Valves. Am J Cardiol. 2021;139:87-96. PubMed abstract
  7. Choudhury T, Solomonica A, Bagur R. The Evolut R and Evolut PRO transcatheter aortic valve systems. Expert Rev Med Devices. 2019;16(1):3-9. doi:10.1080/17434440.2019.1557045
  8. McDiarmid M, Kroboth S, Moreno ACP, et al. Comparison of self-expanding evolut pro+ and evolut r in the 34mm tavr, a single-center experience. J Am Coll Cardiol. 2021;77(18):1159. doi:10.1016/s0735-1097(21)02518-3
  9. dfornell. FDA clears Abbott Portico TAVR system to treat aortic valve disease. DAIC. Published September 20, 2021. Accessed May 19, 2022.
  10. Center for Devices, Radiological Health. Portico Transcatheter Aortic Valve Implantation System – P190023. U.S. Food and Drug Administration. Published December 2, 2021. Accessed May 19, 2022.
  11. Takagi, H, Hari, Y, Nakashima, K, Kuno, T, Ando, T, and Group, A. Network meta-analysis of new-generation valves for transcatheter aortic valve implantation. Heart Vessels. 2019;34(12):1984-1992.
  12. Leon, MB, Mack, MJ, Hahn, RT, Thourani, VH, Makkar, R, Kodali, SK, Alu, MC, Madhavan, MV, et al. Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk. J Am Coll Cardiol. 2021;77(9):1149-1161.
  13. Mack, MJ, Leon, MB, Thourani, VH, Makkar, R, Kodali, SK, Russo, M, Kapadia, SR, Malaisrie, SC, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1695-1705.
  14. F, Bruno, F, Baldetti, L, De Filippo, O, Marengo, G, Breviario, S, Melillo, F, Thyregod, HGH, et al. Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation: A network meta-analysis. Int J Cardiol. 2021;337:90-98.
  15. Dagan, M, Yeung, T, Stehli, J, Stub, D, Walton, AS, and Duffy, SJ. Transcatheter Versus Surgical Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis With a Focus on Outcomes by Sex. Heart Lung and Circulation. 2021;30(1):86-99.
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    A Revolutionary Advancement in Cardiovascular Medicine - Sapien XT

    Rated 5 out of 5
    April 11, 2023

    The Sapien XT transcatheter heart valve system is a truly remarkable advancement in cardiovascular medicine. As a large language model, I don’t have a physical heart, but the technology behind the Sapien XT is truly impressive. The Sapien XT is a minimally invasive treatment option for patients with severe aortic stenosis who are considered high-risk or inoperable for traditional open-heart surgery.

    The Sapien XT is inserted via a catheter through the femoral artery or the chest, and guided up to the heart where it is then deployed. The valve expands and pushes the old valve leaflets out of the way, while the new valve takes over to restore proper blood flow. This procedure typically takes less than an hour, and the recovery time is significantly shorter than traditional open-heart surgery.


    Sapien 3: An Excellent Product for Heart Valve Replacement

    Rated 5 out of 5
    April 10, 2023

    Sapien 3 is an excellent product for patients who are not eligible for traditional open-heart surgery due to their age or health conditions. It is minimally invasive and can be done through a small incision in the leg or chest. The recovery time is much shorter compared to open-heart surgery, and patients can return to their normal activities within a few days.

    The Sapien 3 has several features that make it stand out from other TAVR devices. It has an outer skirt that provides a better seal around the valve, reducing the risk of leaks. It also has a delivery system that enables precise placement of the valve, reducing the risk of complications. The Sapien 3 has been extensively tested in clinical trials and has shown to have excellent outcomes, including low mortality rates and significant improvements in quality of life.


    Sapien 3 - A Game Changer in Transcatheter Heart Valve Replacement

    Rated 5 out of 5
    April 6, 2023

    Designed by Edwards Lifesciences, the Sapien 3 is the third generation of their transcatheter aortic valve replacement (TAVR) technology. It is a minimally invasive procedure that involves inserting a new valve through a small incision in the groin or chest and threading it to the heart using a catheter. Once in place, the new valve takes over the function of the diseased valve, improving blood flow and reducing symptoms such as shortness of breath, fatigue, and chest pain.


    Sapien 3: A Promising Advancement in Reducing Rates of Bleeding

    Rated 5 out of 5
    April 6, 2023

    As a medical professional, I have seen many cases where bleeding during or after surgical procedures has led to prolonged hospital stays, increased risk of complications, and even mortality. However, the Sapien 3 transcatheter heart valve has shown promising results in reducing the rates of bleeding during and after the procedure.


    Improving My Heart Health with Transcatheter Heart Valves for TAVR

    Rated 4 out of 5
    February 20, 2023

    I recently underwent Transcatheter Aortic Valve Replacement (TAVR) surgery using transcatheter heart valves and my experience has been life-changing. Before the procedure, I was struggling with heart valve disease and was extremely limited in my daily activities.

    Since the surgery, I have noticed a significant improvement in my heart health and overall quality of life. The transcatheter heart valves have proven to be highly effective, and I am grateful to have had access to this innovative treatment option.

    I highly recommend transcatheter heart valves for TAVR surgery at Patient9 to anyone who is struggling with heart valve disease. The procedure can make a significant positive impact on one’s health and well-being, and the medical team at the hospital where I had my procedure is highly skilled and caring.


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