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Balloon-expandable (BE) SAPIEN 3 transcatheter heart valves (Edwards Lifesciences, Irvine, CA, USA) have a track record of excellent deliverability, low risk of paravalvular regurgitation (PVL), permanent pacemaker implantation and incidence of stroke. This technology evolved into the current version by reduction of the delivery profile achieved by alignment of the valve on the balloon in the descending aorta, improvement of sealing by the outer PET skirt and use of an expandable, hydrophilic-coated femoral sheath. In February 2019 a new system — SAPIEN 3 Ultra was launched in Poland. It has important new features which warrant discussion: 1) higher outer skirt with redesigned structure, 2) delivery system (low profile nosecone, on-balloon valve crimping, dual articulation), 3) expandable, seamless delivery sheath. The valve CoCr stent, bovine pericardial leaflets, and inner sealing skirt remain unchanged (Fig. 1). The main goals for the design improvements are simplification of the procedure, further reduction of PVL risk and a decrease in vascular complications [1].

SAPIEN 3 Ultra — Design and procedural features of a new balloon-expandable valve