It's tough to know what's "normal" for the natural history of a medical device, but it appears the path to maturity for those first-of-a-kind, high-risk circulatory system devices is more drawn out than in times gone by. Now that TCT 2013 is upon us, we might reflect on a third anniversary of sorts of the Sapien valve, a member of a class of devices that may or may not be described as a mature technology. The fanfare over the Sapien TAVR at TCT 2010 might seem...

SAN FRANCISCO The 2013 edition of Transcatheter Cardiovascular Therapeutics is underway, and the weather in the City by the Bay is remarkably clear, but one thing is not clear regarding transcatheter aortic valve replacements; how their manufacturers will grown their geographic markets in the near term. David Cohen, MD, of the Mid America Heart Institute (Kansas City, Missouri), told attendees that where TAVR is concerned, "the economic issues are paramount," and that at least some research clearly indicates that the technology is as yet too costly for most societies, even many of those in the West.