Heart valve repair and replacement is one of the most innovative and exciting areas in the cardiac devices market. Competitors are constantly fighting to be the first to market with new and innovative technologies.

In many markets, such as the coronary stent market, the technology is largely mature; one clear technology is preferred over the others, with niche uses for the rest. However, due to the incredible complexity of replacing and repairing heart valves, the technology is still far from being ‘solved’.

In recent years, the heart valve market has seen the advent of transcatheter aortic valve implantation (TAVI) technology, which has vastly improved care in the aortic replacement space, as well as providing high growth for many companies pursuing it. TAVI is the next step in the evolution past open-heart surgery to repair the valve. Open-heart surgery was a high-risk procedure with a relatively high rate of death, stroke, or other side effects. TAVI enables surgeons to treat high-risk patients with a fraction of the time and training needed for open-heart surgery. As time passes, more and more evidence seems to point in favour of TAVI being superior to open-heart surgery in terms of surgical outcomes as well.

However, as TAVI develops further, new frontiers are being explored. For example, competitors are already homing in on the mitral valve market. Mitral valve repair has proven to be much harder than aortic valve repair, with its solutions lagging behind TAVI by at least a decade. The Mitraclip, the world’s first transcatheter mitral valve repair (TMVR) device, was released five years ago and continues to gain ground as the only solution in the TMVR market. However, other companies are working hard to develop and sell their own technologies.

In early December 2017, Edwards Lifesciences bought a mitral valve repair start-up, Harpoon Medical. With the promising clinical results of Harpoon Medical’s technology, Edwards Lifesciences hopes to gain a foothold in the TMVR market and compete with Abbott Vascular, the market leader. NeoVasc is working on its own Tiara device, which is designed to replace any mitral valves suffering from regurgitation. However, neither of these products have gained approval yet and as such are lagging far behind the MitraClip. As a result, Abbott Vascular will have many years to solidify its place as the market leader in TMVR solutions.

As competitors flood into the TMVR space, we will doubtless see many strange and innovative technologies in this fresh space, making it worth watching for years to come.