*2.1.5 Biovalve*

Biovalve (Biotronic, Buelach, Switzerland) is a new-generation valve with supraannular structure, consisting of a skirt on a Nitinol roof and three leaflets made from porcine pericardium. This platform presents a large orifice area. The delivery system has a diameter of 18 Fr, suitable for transfemoral access, 360 degree flexible structure and ergonomic design. The valve can be resheathed up to 80% of implantation [20].

*Transcatheter Aortic Valve Replacement Technique and Current Approaches DOI: http://dx.doi.org/10.5772/intechopen.111904*

#### **2.2 Balloon-expandable valves**

Implantation of a transcatheter heart valve (THV) via a balloon-expandable system played an important role in the early stages of TAVR. The first clinical experience started with the Cribier-Edwards valve. After the technological developments, newgeneration devices are made available. BEVs are Saphien family (Edwards Lifesciences Corporation, Irvine, CA, USA), Myval (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India), Inovare (Braile Biomedical, São José do Rio Preto, Brazil) and Colibri (Colibri Heart Valve, Broomfield, USA). All BEVs are placed in an intra-annular position.

#### *2.2.1 Saphien BEV family*

Saphien is the first BEV. This family includes Saphien XT, Saphien 3 and Saphien 3 Ultra. The valves are made of tri-leaflet bovine pericardium mounted on a cobaltchromium stent frame (**Figure 5**). Saphien XT valves are available in 20, 23, 26 and 29 mm sizes. This platform uses a 16 F sheath for 20 and 23 mm valves, 18 F sheath for a 26 mm valve and 20 F sheath for a 29 mm valve. Saphien 3 platform is compatible with the 14 F sheath for the 20 mm, 23 mm, and 26 mm valves and with the 16 F sheath for the 29 mm valve. All these sheaths are expandable and called 'eSheath'. Sapien 3 and Sapien 3 Ultra valves are suitable for transfemoral processing up to 5.5 mm femoral artery diameter. The major improvement in Sapien 3 is polyethylene

**Figure 5.** *Saphien BEV family.*


#### **Table 2.**

*Recommendations for [all conditions].*

terephthalate (PET) outer skirt to reduce PVL and an open cell upper frame geometry to avoid obstruction and allow access to coronary arteries [21]. The last generation of Saphien family is Saphien 3 Ultra. This valve is based on Saphien 3 platform but has 40% taller skirt design to avoid PVL better. The 20, 23 and 26 mm valves feature a new skirt design, while the 29 mm valve remains in the existing Saphien 3 platform [22].

Saphien 3 and Saphien 3 Ultra have some unique indications for use. The Food Drug and Administration (FDA) has approved them for mitral and pulmonary procedures. But this issue is beyond the scope of this article (**Table 2**).
