Pushing the Envelope for Transcatheter Valve Interventions in Canada

Authors

  • Bryan Traynor, MD Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario
  • Akshay Bagai, MD, MHS Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario

DOI:

https://doi.org/10.58931/cct.2025.126

Abstract

Transcatheter valve interventions (TVIs) have revolutionized the treatment of structural heart disease, by providing a less invasive option to surgical valve repair or replacement for patients. Canada has been at the forefront of adopting these therapies, yet significant challenges remain. These include expanding indications, training operators, optimizing access, and integrating these rapidly evolving procedures into a government-funded single-access healthcare system. This review explores the current landscape of TVIs in Canada. We discuss the necessity for centres of excellence, training pathways for operators, and the multidisciplinary infrastructure required to ensure equitable and high-quality care.

Author Biographies

Bryan Traynor, MD, Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario

Dr. Bryan Traynor, MB BCh graduated from Trinity College, Dublin, Ireland in 2015. He completed his general internal medicine (MRCPI 2017) and cardiology specialist training (CSCST 2024) through the RCPI in Ireland. Following his specialist training he undertook a 1-year subspecialty fellowship in interventional cardiology at the Mater Misericordiae University Hospital in Dublin. He then completed a further 2-year fellowship in complex coronary and structural heart disease intervention at St. Michael’s Hospital, University of Toronto. He returned to Ireland as a consultant cardiologist at Cork University Hospital in August 2025.

Akshay Bagai, MD, MHS, Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario

Dr. Akshay Bagai is a practicing interventional cardiologist at St. Michael’s Hospital and an Associate Professor in the Department of Medicine at the University of Toronto. Dr. Bagai received his MD and trained in Internal Medicine and Cardiology at the University of Toronto. He completed his training in Interventional Cardiology at St. Michael’s Hospital. He obtained a Masters degree in Health Sciences from the Clinical Research Training Program at Duke University, USA. He returned to Toronto and joined the Division of Cardiology at St. Michael’s Hospital in August 2013. His clinical and research interests are closely aligned and include complex, high risk, and total occlusion percutaneous coronary intervention, and transcatheter interventions for mitral and tricuspid valve disease.

References

RT, Genereux P, et al. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med. 2023;389(21):1949–1960. doi:10.1056/NEJMoa2307447 DOI: https://doi.org/10.1056/NEJMoa2307447

Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706–1715. doi:10.1056/NEJMoa1816885 DOI: https://doi.org/10.1056/NEJMoa1816885

Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. 2020;382(9):799–809. doi:10.1056/NEJMoa1910555 DOI: https://doi.org/10.1056/NEJMoa1910555

Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385(9986):2477–2484. doi:10.1016/S0140-6736(15)60308-7 DOI: https://doi.org/10.1016/S0140-6736(15)60308-7

Thyregod HGH, Jorgensen TH, Ihlemann N, Steinbruchel DA, Nissen H, Kjeldsen BJ, et al. Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial. Eur Heart J. 2024;45(13):1116–1124. doi:10.1093/eurheartj/ehae043 DOI: https://doi.org/10.1093/eurheartj/ehae043

Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376(14):1321–1331. doi:10.1056/NEJMoa1700456 DOI: https://doi.org/10.1056/NEJMoa1700456

Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–1798. doi:10.1056/NEJMoa1400590 DOI: https://doi.org/10.1056/NEJMoa1400590

Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, 3rd, Gentile F, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72–e227. doi:10.1161/CIR.0000000000000923 DOI: https://doi.org/10.1161/CIR.0000000000000923

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2021;60(4):727–800. doi:10.1093/ejcts/ezab389 DOI: https://doi.org/10.1093/ejcts/ezac209

Asgar AW, Ouzounian M, Adams C, Afilalo J, Fremes S, Lauck S, et al. 2019 Canadian Cardiovascular Society position statement for transcatheter aortic valve implantation. Can J Cardiol. 2019;35(11):1437–1448. doi:10.1016/j.cjca.2019.08.011 DOI: https://doi.org/10.1016/j.cjca.2019.08.011

Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Eitel I, et al. Comparison of newer generation self-expandable vs. balloon-expandable valves in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial. Eur Heart J. 2020;41(20):1890–1899. doi:10.1093/eurheartj/ehaa036 DOI: https://doi.org/10.1093/eurheartj/ehaa036

Abdel-Wahab M, Mehilli J, Frerker C, Neumann FJ, Kurz T, Tolg R, et al. Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA. 2014;311(15):1503–1514. doi:10.1001/jama.2014.3316 DOI: https://doi.org/10.1001/jama.2014.3316

Lanz J, Kim WK, Walther T, Burgdorf C, Mollmann H, Linke A, et al. Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial. Lancet. 2019;394(10209):1619–1628. doi:10.1016/S0140-6736(19)32220-2 DOI: https://doi.org/10.1016/S0140-6736(19)32220-2

Zhang XL, Wei ZH, Wang HW, Xu W, Wang Y, Xu B. Early and midterm outcomes of transcatheter aortic-valve replacement with balloon-expandable versus self-expanding valves: a meta-analysis. J Cardiol. 2022;80(3):204–210. doi:10.1016/j.jjcc.2022.04.011 DOI: https://doi.org/10.1016/j.jjcc.2022.04.011

Wijeysundera HC, Qiu F, Koh M, Prasad TJ, Cantor WJ, Cheema A, et al. Comparison of outcomes of balloon-expandable versus self-expandable transcatheter heart valves for severe aortic stenosis. Am J Cardiol. 2017;119(7):1094–1099. doi:10.1016/j.amjcard.2016.12.016 DOI: https://doi.org/10.1016/j.amjcard.2016.12.016

Herrmann HC, Mehran R, Blackman DJ, Bailey S, Mollmann H, Abdel-Wahab M, et al. Self-expanding or balloon-expandable TAVR in patients with a small aortic annulus. N Engl J Med. 2024;390(21):1959–1971. doi:10.1056/NEJMoa2312573 DOI: https://doi.org/10.1056/NEJMoa2312573

Sondergaard L, Walton AS, Worthley SG, Smith D, Chehab B, Manoharan G, et al. Thirty-day and one-year outcomes of the Navitor transcatheter heart valve in patients with aortic stenosis: the prospective, multicentre, global PORTICO NG Study. EuroIntervention. 2023;19(3):248–255. doi:10.4244/EIJ-D-22-01108

Aoun J, Zaid S, Goel S, Reardon MJ. A Comprehensive Evaluation of the NAVITOR Transcatheter Aortic Valve Replacement System. Heart Int. 2024;18(1):26–29. doi:10.17925/HI.2024.18.1.4 DOI: https://doi.org/10.17925/HI.2024.18.1.4

Albassam O, Henning KA, Qiu F, Cram P, Sheth TN, Ko DT, et al. Increasing wait-time mortality for severe aortic stenosis: a population-level study of the transition in practice from surgical aortic valve replacement to transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2020;13(11):e009297. doi:10.1161/CIRCINTERVENTIONS.120.009297 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.120.009297

Miranda RN, Qiu F, Manoragavan R, Austin PC, Naimark DMJ, Fremes SE, et al. Transcatheter aortic valve implantation wait-time management: derivation and validation of the Canadian TAVI triage tool (CAN3T). J Am Heart Assoc. 2024;13(5):e033768. doi:10.1161/JAHA.123.033768 DOI: https://doi.org/10.1161/JAHA.123.033768

Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;76(9):1018–1030. doi:10.1016/j.jacc.2020.07.005 DOI: https://doi.org/10.1016/j.jacc.2020.07.005

Williams MR, Jilaihawi H, Makkar R, O’Neill WW, Guyton R, Malaisrie SC, et al. The PARTNER 3 bicuspid registry for transcatheter aortic valve replacement in low-surgical-risk patients. JACC Cardiovasc Interv. 2022;15(5):523–532. doi:10.1016/j.jcin.2022.01.279 DOI: https://doi.org/10.1016/j.jcin.2022.01.279

Genereux P, Schwartz A, Oldemeyer JB, Pibarot P, Cohen DJ, Blanke P, et al. Transcatheter aortic-valve replacement for asymptomatic severe aortic stenosis. N Engl J Med. 2025;392(3):217–227. doi:10.1056/NEJMoa2405880 DOI: https://doi.org/10.1056/NEJMoa2405880

Van Mieghem NM, Elmariah S, Spitzer E, Pibarot P, Nazif TM, Bax JJ, et al. Transcatheter Aortic valve replacement in patients with systolic heart failure and moderate aortic stenosis: TAVR UNLOAD. J Am Coll Cardiol. 2025;85(9):878–890. doi:10.1016/j.jacc.2024.10.070 DOI: https://doi.org/10.1016/j.jacc.2024.10.070

Harvey JE, 3rd, Kapadia SR, Cohen DJ, Kalra A, Irish W, Gunnarsson C, et al. Trends in complications among patients undergoing aortic valve replacement in the United States. J Am Heart Assoc. 2024;13(17):e031461. doi:10.1161/JAHA.123.031461 DOI: https://doi.org/10.1161/JAHA.123.031461

Eggebrecht H, Mehta RH, Haude M, Sack S, Mudra H, Hein R, et al. Transcatheter aortic valve implantation (TAVI) by centres with and without an on-site cardiac surgery programme: preliminary experience from the German TAVI registry. EuroIntervention. 2014;10(5):602–608. doi:10.4244/EIJV10I5A105 DOI: https://doi.org/10.4244/EIJV10I5A105

Tarantini G, Tang G, Nai Fovino L, Blackman D, Van Mieghem NM, Kim WK, et al. Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery. EuroIntervention. 2023;19(1):37–52. doi:10.4244/EIJ-D-22-00958 DOI: https://doi.org/10.4244/EIJ-D-22-00958

Hensey M, Murdoch DJ, Sathananthan J, Alenezi A, Sathananthan G, Moss R, et al. First-in-human experience of a new-generation transfemoral transcatheter aortic valve for the treatment of severe aortic regurgitation: the J-Valve transfemoral system. EuroIntervention. 2019;14(15):e1553–e1555. doi:10.4244/EIJ-D-18-00935 DOI: https://doi.org/10.4244/EIJ-D-18-00935

Vahl TP, Thourani VH, Makkar RR, Hamid N, Khalique OK, Daniels D, et al. Transcatheter aortic valve implantation in patients with high-risk symptomatic native aortic regurgitation (ALIGN-AR): a prospective, multicentre, single-arm study. Lancet. 2024;403(10435):1451–1459. doi:10.1016/S0140-6736(23)02806-4 DOI: https://doi.org/10.1016/S0140-6736(23)02806-4

Alfieri O, Maisano F, De Bonis M, Stefano PL, Torracca L, Oppizzi M, et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg. 2001;122(4):674–681. doi:10.1067/mtc.2001.117277 DOI: https://doi.org/10.1067/mtc.2001.117277

Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014;64(2):182–192. doi:10.1016/j.jacc.2013.10.021 DOI: https://doi.org/10.1016/j.jacc.2013.10.021

Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307–2318. doi:10.1056/NEJMoa1806640 DOI: https://doi.org/10.1056/NEJMoa1806640

Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379(24):2297–2306. doi:10.1056/NEJMoa1805374 DOI: https://doi.org/10.1056/NEJMoa1805374

Anker SD, Friede T, von Bardeleben RS, Butler J, Khan MS, Diek M, et al. Transcatheter valve repair in heart failure with moderate to severe mitral regurgitation. N Engl J Med. 2024;391(19):1799–1809. doi:10.1056/NEJMoa2314328 DOI: https://doi.org/10.1056/NEJMe2410896

Mehta SR, Asgar A, Boone R, Rodes-Cabau J, Cohen EA, Czarnecki A, et al. Efficacy and safety of transcatheter mitral valve edge-to-edge repair with a MitraClip device in real-world Canadian practice. CJC Open. 2025. https://doi.org/10.1016/j.cjco.2025.05.008 DOI: https://doi.org/10.1016/j.cjco.2025.05.008

Zahr F, Smith RL, Gillam LD, Chadderdon S, Makkar R, von Bardeleben RS, et al. One-year outcomes from the CLASP IID randomized trial for degenerative mitral regurgitation. JACC Cardiovasc Interv. Published online October 26, 2023. doi:10.1016/j.jcin.2023.10.002 DOI: https://doi.org/10.1016/j.jcin.2023.10.002

Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Ozturk C, et al. Early outcomes of 2 mitral valve transcatheter leaflet approximation devices: a propensity score-matched multicenter comparison. JACC Cardiovasc Interv. 2022;15(24):2541–2551. doi:10.1016/j.jcin.2022.10.008 DOI: https://doi.org/10.1016/j.jcin.2022.10.008

Zahr F, Song HK, Chadderdon S, Gada H, Mumtaz M, Byrne T, et al. 1-year outcomes following transfemoral transseptal transcatheter mitral valve replacement: Intrepid TMVR early feasibility study results. JACC Cardiovasc Interv. 2023;16(23):2868–2879. doi:10.1016/j.jcin.2023.10.001 DOI: https://doi.org/10.1016/j.jcin.2023.10.001

Webb JG, Murdoch DJ, Boone RH, Moss R, Attinger-Toller A, Blanke P, et al. Percutaneous transcatheter mitral valve replacement: first-in-human experience with a new transseptal system. J Am Coll Cardiol. 2019;73(11):1239–1246. doi:10.1016/j.jacc.2018.12.065 DOI: https://doi.org/10.1016/j.jacc.2018.12.065

Muller DWM, Sorajja P, Duncan A, Bethea B, Dahle G, Grayburn P, et al. 2-year outcomes of transcatheter mitral valve replacement in patients with severe symptomatic mitral regurgitation. J Am Coll Cardiol. 2021;78(19):1847–1859. doi:10.1016/j.jacc.2021.08.060 DOI: https://doi.org/10.1016/j.jacc.2021.08.060

Scotti A, Coisne A, Granada JF. Screening for TMVR: a glimpse into the future technological needs and requirements. Can J Cardiol. 2023;39(5):590–592. doi:10.1016/j.cjca.2023.03.004 DOI: https://doi.org/10.1016/j.cjca.2023.03.004

Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43(3):405–409. doi:10.1016/j.jacc.2003.09.036 DOI: https://doi.org/10.1016/j.jacc.2003.09.036

Ambrosino M, Sangoi M, Monzer N, Irving B, Fiorilli P, Khazan B, et al. Tricuspid regurgitation: a review of current interventional management. J Am Heart Assoc. 2024;13(6):e032999. doi:10.1161/JAHA.123.032999 DOI: https://doi.org/10.1161/JAHA.123.032999

Kar S, Makkar RR, Whisenant BK, Hamid N, Naik H, Tadros P, et al. Two-year outcomes of transcatheter edge-to-edge repair for severe tricuspid regurgitation: the TRILUMINATE pivotal randomized controlled trial. Circulation. 2025;151(23):1630–1638. doi:10.1161/CIRCULATIONAHA.125.074536 DOI: https://doi.org/10.1161/CIRCULATIONAHA.125.074536

Wild MG, Stolz L, Rosch S, Rudolph F, Goebel B, Koll B, et al. transcatheter valve repair for tricuspid regurgitation: 1-year results from a large European real-world registry. J Am Coll Cardiol. 2025;85(3):220–231. doi:10.1016/j.jacc.2024.10.068 DOI: https://doi.org/10.1016/j.jacc.2024.10.068

Hahn RT, Makkar R, Thourani VH, Makar M, Sharma RP, Haeffele C, et al. Transcatheter valve replacement in severe tricuspid regurgitation. N Engl J Med. 2025;392(2):115–126. doi:10.1056/NEJMoa2401918 DOI: https://doi.org/10.1056/NEJMoa2401918

Downloads

Published

2025-09-29

How to Cite

1.
Traynor B, Bagai A. Pushing the Envelope for Transcatheter Valve Interventions in Canada. Can Cardiol Today [Internet]. 2025 Sep. 29 [cited 2025 Oct. 4];1(2):4–14. Available from: https://canadiancardiologytoday.com/article/view/1-2-Traynor_et_al

Issue

Volume 1, Issue 2, Summer 2025

Section

Articles

License

Copyright (c) 2025 Canadian Cardiology Today

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.