SAN FRANCISCO — The annual meeting known as Transcatheter Cardiovascular Therapeutics typically features some interesting but not unpredictable developments, a statement that applies to this year's edition as well . . . for the most part. There is of course the not-unexpected continuation of uneven evidence for PFO closure and news of a TAVR competitor for Edwards Lifesciences (Irvine, California) and Medtronic (Minneapolis), but the strangest noise is just a noise, although it's about the most obnoxious noise heard since the invention of techno.

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...