TCT 2026: Cardiovascular innovation advances earlier intervention and treatment efficiency

Earlier intervention, meaningful improvements in quality of life and more efficient treatment pathways were central themes at TCT 2026. Marcel Fritsch and Lorenzo Zignani from Bellevue Asset Management attended the conference in San Diego to assess the latest clinical developments and innovations in cardiovascular medtech. The conference reinforced our confidence in the breadth of cardiovascular innovation and its potential to create lasting value for patients, healthcare systems and investors.

TCT once again brought together clinical research, procedural expertise and emerging technologies. Its combination of major clinical trial datas, live cases and the MedTech Innovation Forum makes it a particularly valuable platform for assessing how new evidence could translate into clinical practice. Our assessment of this year’s meeting is constructive: several important studies strengthened the evidence supporting established technologies, while ongoing clinical programmes point to further growth opportunities.

Edwards Lifesciences’ PROGRESS trial was a major highlight. Among 744 patients with moderate aortic stenosis and additional risk factors, early transcatheter aortic valve replacement, or TAVR, reduced the two-year incidence of death or a heart-failure event from 23.9% to 16.7%. The benefit was driven by fewer heart failure events; mortality was not significantly reduced. These results provide an important foundation for considering earlier intervention in selected patients. From an investment perspective, they strengthen the potential for TAVR to treat a broader patient population, with the pace of adoption dependent on regulatory decisions, reimbursement and clinical implementation.

The EARLY TAVR economic analysis provided further evidence to this discussion. In patients with asymptomatic severe aortic stenosis, early treatment was projected to be cost-effective from a US healthcare system perspective, at approximately USD 14,700 per quality-adjusted life-year gained. Lifetime costs were modestly higher, accompanied by projected health outcomes improved. This evidence is also relevant from an investment perspective: demonstrating value for healthcare systems can support the broader adoption of clinically effective technologies.

Progress also extended to tricuspid valve disease. In the CLASP II TR trial, Edwards’ PASCAL repair system met its six-month primary endpoint, with the benefit primarily driven by improvements in quality of life. Patients experienced substantial reductions in tricuspid regurgitation, although mortality and heart failure hospitalizations did not differ significantly at one year. For symptomatic patients with limited treatment options, improvements in daily functioning are meaningful. The findings strengthen clinical evidence supporting transcatheter repair and illustrate the expanding range of treatments for structural heart disease.

The P4 trial highlighted the role of imaging and procedural planning. CT-guided coronary intervention met the trial’s noninferiority criterion compared with intravascular ultrasound guidance, with one-year target-vessel failure rates of 4.1% and 4.6%, respectively. Median procedure time was 46 minutes compared with 63 minutes. These results support the potential for advanced planning to improve procedural efficiency while maintaining clinical outcomes within the study’s predefined margin. The reported procedure times exclude the preceding CT scan and planning, so the economic impact across the entire treatment pathway remains to be established. From an investment perspective, the study provides further evidence of the potential in cardiovascular imaging and software.

Left atrial appendage closure also continued to advance. Abbott’s VERITAS study provided supportive one-year follow-up data for Amulet 360, adding evidence on the performance of its next-generation device. The SIMPLAAFY trial addressed a complementary question: how to manage medication after implantation. Following successful, uncomplicated Watchman FLX Pro procedures, aspirin alone and a reduced-dose anticoagulation strategy both met the criteria for noninferiority compared with dual antiplatelet therapy for the six-month composite endpoint. Together, these studies demonstrate progress in both device technology and the surrounding care pathway. Abbott’s PARADIGM study further illustrated the breadth of structural-heart innovation through dedicated treatment of leaks around surgically implanted replacement valves.

The clinical development pipeline remains active. Medtronic presented the study and baseline patient characteristics of EXPAND TAVR II, which is investigating earlier intervention in moderate aortic stenosis using the Evolut platform. Clinical outcomes are still pending, making this an important source of future clinical evidence. Alongside the newer technologies shown at TCT’s innovation sessions, such programmes represent further potential clinical and commercial milestones.

TCT reinforced our view that cardiovascular medtech offers a combination of established market leaders and emerging growth opportunities. Realizing that potential requires careful assessment of clinical benefit, market adoption, reimbursement and valuation. We see particular potential in companies that can translate robust clinical evidence into treatments that are adopted by physicians and supported by healthcare systems. This year’s conference provided substantial reasons for confidence in that innovation pipeline and valuable evidence to guide selective, long-term investment.