The next generation SAPIEN 3 Ultra (Edwards Lifesciences, CA, USA) builds on the success of the SAPIEN 3 (S3) transcatheter heart valve. The textured polyethylene terephthalate external skirt is 40% taller than the S3 valve skirt. The Edwards Commander delivery system and Edwards eSheath remain unchanged from S3 with proven results regarding valve deliverability and low rates of vascular complications.