ESC Cardio Talk Journal editorial - The emerging story of Myval transcatheter heart valve: lessons from the LANDMARK trial
Nov 24, 2025
Paolo Springhetti, a Milanese cardiologist specializing in transcatheter valve therapies, joins Marie-Annick Clavel to discuss the LANDMARK trial findings. They dive into the unique sizing advantages of Myval compared to competitors, highlighting impressive hemodynamic outcomes. Sex-specific definitions of patient-prosthesis mismatch (PPM) come under scrutiny, revealing stark differences among valve types. The duo also explores the implications of Myval's low-flow recovery and durability concerns for younger patients, emphasizing the need for long-term studies.
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Randomized Head-to-Head Hemodynamic Finding
- The LANDMARK trial randomized >750 patients comparing Myval, Sapien, and Evolut with core-lab echo at 30 days.
- Myval showed hemodynamic device success similar to Evolut and superior to Sapien in this early analysis.
PPM Differences Between Valve Platforms
- Prosthesis–patient mismatch (PPM) differed across platforms with Myval intermediate between Sapien and Evolut.
- This raises questions about how valve sizing and design affect indexed orifice area outcomes.
Questioning One-Size PPM Thresholds
- Current PPM thresholds derive from surgical data and may not capture tolerance differences by sex.
- Marie-Annick Clavel and Paolo suggest exploring sex-specific PPM definitions because women may tolerate smaller effective orifice areas better.