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TCTAP 2025

Lessons and Future Challenges in Transcatheter SHD Therapies

At TCTAP 2025, Martin B. Leon, MD (NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, USA), will deliver a focused lecture titled “Lessons and Future Challenges in Transcatheter SHD Therapies.” The presentation will explore how structural heart disease (SHD) therapies have evolved and what critical developments will define the future of transcatheter valvular intervention. He will first address the ongoing global crisis in under-diagnosis and under-treatment of valvular heart disease (VHD) despite the development of less-invasive therapies. He will emphasize that key systemic barriers—limited procedural capacity, imaging infrastructure, and inadequate reimbursement policies—continue to restrict access to care. These limitations will need to be addressed to extend the benefits of SHD interventions more broadly, particularly in low-resource settings and among underserved populations. He will underline the enduring importance of the multidisciplinary Heart Valve Team. While this model has proven effective in TAVR programs, it will require adaptation for more complex procedures such as mitral and tricuspid valve repair or replacement. He will highlight that heart failure specialists, electrophysiologists, and imaging experts will become essential partners in the care of patients undergoing mitral and tricuspid interventions, where anatomical variability is high, and device positioning is more demanding. A major focus of the lecture will be the principle of procedural and device simplification. He will assert that ease of use, reproducibility, and anatomical adaptability are essential features for future SHD devices. Drawing from the global adoption of TAVR, which succeeded due to intuitive device deployment, simplified imaging requirements, and favorable safety profiles, he will state that similar criteria must be met for next-generation mitral and tricuspid therapies to gain clinical and commercial traction. He will also reference data showing that nearly 50% of patients referred for transcatheter mitral interventions are excluded due to anatomical mismatch, underscoring the urgent need for technologies that can accommodate complex and varied anatomies. In discussing trial design, he will review the shift from traditional endpoints such as mortality and stroke to more complex composite endpoints and patient-reported outcomes. He will explain how statistical approaches like the WIN ratio and Bayesian modeling are increasingly used in SHD trials, particularly in the context of mitral and tricuspid valve therapies. However, he will caution that these evolving methodologies can complicate interpretation and may limit the generalizability of trial findings unless adequately powered and pragmatically designed. He will also present an overview of current investigational platforms such as Evoque, AltaValve, M3, and CardioValve. These devices will be characterized by enhanced deliverability, improved leaflet design, and adaptability to anatomical variations. He will describe how future development will be supported by adjunctive tools including three-dimensional imaging, artificial intelligence-guided planning, and real-time intraprocedural feedback systems. The topic of valve durability will be addressed with reference to the expanding population of younger, lower-risk patients undergoing TAVR. He will emphasize the need for long-term follow-up data—spanning at least 10 years—for all transcatheter devices, especially as valve-in-valve procedures and surgical explants become more common. He will present findings related to structural valve deterioration, hemodynamic performance, and reintervention rates as key metrics for future studies. Finally, he will call for broader systemic readiness to support innovation. He will advocate for the incorporation of real-world data, revised consensus definitions, and flexible regulatory pathways that can accommodate the dynamic nature of SHD technologies. He will stress that success in this field will depend on technological progress and meaningful clinical endpoints, inclusive patient access, and health system adaptability. His lecture will provide a critical, evidence-based framework for understanding how transcatheter SHD therapies will evolve over the next decade. By focusing on access, anatomical compatibility, simplified delivery, and long-term durability, the field will be better positioned to meet the complex needs of patients with valvular heart disease. (Figure 1.) 30 Years Special Keynote Lectures Thursday, April 24, 11:35 AM-11:59 AM Main Arena, Level 3 Check The Session

April 24, 2025 247

TCTAP 2025

How Art and Science Work Together to Advance New Device Technology

At TCTAP 2025, Ian Penn, MD, MFA (Vancouver General, Canada), will present a compelling exploration of the intersection between art and science, framed through problem-solving. His journey from leading innovations in interventional cardiology to creating thought-provoking visual art embodies the belief that transformative solutions arise not from chasing answers but from deeply understanding the problem. Describing science and art as the “Yin and Yang of understanding,” he emphasizes how these disciplines complement each other, grounded in curiosity, creativity, and a shared commitment to exploration. This unified mindset of “loving the problem” has guided his approach to stent design and artistic expression. He contributed to advances in coronary bifurcation stenting, addressing the technical dilemma of balancing stent deliverability with complete lesion coverage. Collaborating with leaders like Marty Leon and Richard Schatz, he later extended these principles to neurovascular interventions, drawing inspiration from natural forms such as feathers to tackle the complexities of bifurcation aneurysms. The lecture will also explore how a crisis can serve as a powerful catalyst for reinvention. An occupational spinal disease, a common affliction among interventional cardiologists, ended his time in the lab. His transition into art school began a second journey. Through a problem-solving lens, he explored new media and storytelling forms. In portraiture, he addressed the challenge of authentically capturing identity by engaging deeply with subjects, recording conversations, and creating animated images that distilled their essence. In landscape work, particularly during COVID-19 isolation, he painted clouds from a fixed vantage point, capturing the emotional weight of the pandemic, political upheaval, and global conflict reflected in the ever-changing sky (Figure 1). Figure 1. Selected artwork of Dr. Penn, a visual reflection on collective uncertainty and resilience during the COVID-19 pandemic. His artistic pursuits also found purpose in public service. Through the IDEA award, he helped bridge medicine and art by integrating creative works into clinical environments, demonstrating art’s therapeutic role and potential to humanize healthcare spaces. His work reminds us that innovation emerges through persistent engagement with complexity. By embracing both the analytical rigor of science and the emotional depth of art, his career demonstrates how a shared problem-solving ethos can advance technology, deepen empathy, and transform practice. 30 Years Special Keynote Lectures Thursday, April 24, 11:35 AM-11:59 AM Main Arena, Level 3 Check The Session

April 24, 2025 270

COMPLEX PCI 2024

Advanced Techniques for Managing Severe Coronary Calcification

Severe coronary calcification poses significant challenges in percutaneous coronary intervention (PCI), requiring advanced imaging and innovative procedural strategies to improve patient outcomes. At the COMPLEX PCI 2024 conference, Takashi Akasaka, MD (ishinomiya Watanabe Cardiovascular Cerebral Center, Japan), delivered a comprehensive presentation detailing the latest techniques and tools for addressing this difficult subset of patients. Challenges of Severe Coronary Calcification He emphasized that severe coronary calcification significantly increases the risks of stent under-expansion, vessel damage, and restenosis. Lesions with circumferential calcium exceeding 180 degrees are particularly difficult to manage, necessitating a systematic approach involving imaging and calcium modification techniques. The Role of Advanced Imaging Intravascular imaging plays a crucial role in the successful treatment of calcified lesions. Optical coherence tomography (OCT) is particularly effective for visualizing calcium thickness and distribution, while intravascular ultrasound (IVUS) provides higher sensitivity in detecting calcium. He recommended a dual-modality approach combining OCT and IVUS for comprehensive lesion assessment and procedural planning. Innovative Calcium Modification Techniques He presented recent advances in lesion preparation, highlighting the importance of calcium modification techniques to facilitate optimal stent deployment. Tools such as rotational atherectomy, orbital atherectomy, intravascular lithotripsy (IVL), and scoring or cutting balloons were discussed as key options for addressing heavily calcified lesions. IVL, in particular, was noted for its ability to fracture thick calcium layers exceeding 500 microns, which are often resistant to traditional balloon dilation. This technique has shown promising results in improving stent expansion and reducing the risk of restenosis. Challenges with Calcified Nodules Calcified nodules, particularly the "elapsed" type, remain a significant challenge in PCI. These lesions are associated with worse clinical outcomes and higher target lesion revascularization rates. He noted that while current treatment options such as drug-eluting stents (DES) and drug-coated balloons (DCB) have shown limited success, further innovation is required to address this unmet need. Key Takeaways He concluded the presentation with several take-home messages: Intravascular imaging with OCT and IVUS is essential for accurate assessment and treatment planning. Calcium modification techniques, such as IVL and atherectomy, are critical for procedural success in severely calcified lesions. The management of calcified nodules remains a pressing challenge, requiring continued research and innovation. The insights shared at Complex PCI 2024 underscore the importance of combining advanced imaging with innovative procedural strategies to optimize outcomes in patients with severe coronary calcification. As the field continues to evolve, these advancements pave the way for better care and improved prognoses in this challenging patient population. Live Case 3: Imaging and Physiology / Calcification Friday, November 29, 12:40 PM ~ 2:30 PM Main Arena Check The Session

January 03, 2025 15429

COMPLEX PCI 2024

State-of-the-Art Left Main PCI

At the 9th COMPLEX PCI 2024 conference, Duk-Woo Park, MD, PhD (Asan Medical Center, Korea), delivered a thought-provoking plenary lecture on “State-of-the-Art Left Main PCI: Current Evidence and What Are the Next?”. His presentation offered a meticulous exploration of the latest advancements in managing left main coronary artery disease (LMCAD), combining evidence-based practices, cutting-edge technologies, and a patient-centered approach. He emphasized the transformative role of multidisciplinary Heart Teams in guiding treatment decisions for LMCAD. Highlighting updates from the 2024 European Society of Cardiology (ESC) guidelines, he pointed out the growing reliance on randomized controlled trials (RCTs), which have shaped current clinical approaches. The nuanced interplay between patient-specific factors and anatomical complexity underscores the importance of collaborative decision-making when choosing between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Intracoronary imaging and physiological assessments took center stage as he outlined their critical role in procedural success. Tools like intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) are now indispensable in addressing lesion severity, ensuring precise stent placement, and optimizing outcomes. Recent RCTs such as RENOVATE-COMPLEX and OCTIVUS have consistently demonstrated improved outcomes with imaging-guided PCI, reducing target vessel failure and major adverse cardiac events. He shared advanced criteria for stent optimization, including minimum stent area thresholds for left main arteries, developed at Asan Medical Center. For example, achieving an MSA of ≥8 mm² for the proximal left main is a key determinant of long-term success. He introduced emerging stent technologies, including the DynamX bioadaptive stent, and discussed novel techniques like DK-CRUSH and TAP for managing bifurcation lesions. Studies such as INFINITY-SWEDEHEART and DCB-BIF highlight the benefits of these innovations, from enhanced vessel function to reduced target lesion failure rates. Physiology-guided approaches, such as FFR, address the "visual-functional mismatch" often seen in left main lesions, ensuring interventions are limited to functionally significant stenoses. He discussed ongoing trials, including the FATE-MAIN study, which is poised to refine these strategies further. In addition, he outlined a tiered decision-making framework that incorporates imaging and physiology to assess intermediate lesions, integrating anatomical and functional data for precise stratification. He explored emerging tools like artificial intelligence (AI) and predictive algorithms that promise to revolutionize imaging-guided PCI by automating risk assessment and stent optimization. He also touched on evolving antiplatelet regimens, referencing findings from the TAILORED-CHIP trial, which balance thrombotic and bleeding risks through personalized therapy. In conclusion, he underscored the importance of collaboration, technological innovation, and adherence to evidence-based protocols in left main PCI. He expressed optimism about the growing capabilities of PCI techniques, which are now achieving outcomes comparable to CABG in complex cases. His lecture not only illuminated the latest advancements but also provided a forward-looking framework for interventional cardiologists navigating the complexities of LMCAD. Opening & Complex PCI Workshop 1: Left Main & Bifurcation Thursday, November 28, 1:00 PM ~ 2:15 PM Main Arena Check The Session

December 27, 2024 2899

COMPLEX PCI 2024

Left Main and Multi-vessel Disease: Updated Treatment Concept

‘Left Main and Multi-vessel Disease: Updated Treatment Concept’ Seung-Jung Park, MD, PhD (Asan Medical Center, Korea), stresses that left main (LM) disease is no longer surgical disease. Until now, LM disease was considered to require surgical revascularization. However, recent clinical trials such as SYNTAX, PRECOMBAT, EXCEL, NOBLE and meta-analysis have led to changes in the recent ESC and ACC/AHA guidelines for LM disease revascularization. 2024 ESC guidelines for revascularization of LM disease categorize LM disease and LM disease with multivessel disease into categories based on SYNTAX score: low complexity is classified as Ia, intermediate as IIa, and for LM disease with multivessel disease, PCI is indicated as IIb if surgical risk is high. 2021 ACC/AHA guidelines classified LM disease revascularization as IIa for low anatomic complexity. However, the global guidelines do not take into account the operator's experience and technical considerations. For example, the left main artery is a large vessel with a proximal lesion and a short lesion length, making it suitable for PCI, and contemporary PCI is physiology- and image-guided PCI, so the global guidelines should reflect this, he pointed. Current Asan Medical Center practice for Left Main Disease There have also been changes in the ESC guidelines for multivessel disease. 2024 ESC multivessel disease revascularization guideline categorize multivessel disease with diabetes and without diabetes. Even in patients with diabetes, PCI is IIa if the surgical risk is high. And in the case of multivessel disease without diabetes, it is almost always Ia. And in the multivessel disease guideline, PCI is no longer classified as III. Current Asan Medical Center practice for Left Main Disease PCI Favour; All ischemic lesions, favourable anatomy for PCI (RVD > 2.5mm, and/or Lesion length < 50mm) CABG Favour; Low EF (< 40%), Diabetic, 3 vessel disease, unfavourable anatomy for PCI Majority of multi-vessel disease, 1 or 2 major vessel PCI with optical medical therapy would be enough. He concluded his lecture by saying that randomized studies are needed to confirm the results because it is not known which outcome is better, contemporary PCI or CABG, in patients with multivessel disease with ischemic cardiomyopathy and multivessel disease with diabetes. Live Case 1: Left Main & Multi-vessel Diseases Friday, November 29, 9:00 AM ~ 10:50 AM Main Arena Check The Session

December 20, 2024 2906

COMPLEX PCI 2024

Predicting Side Branch Occlusion in Left Main Bifurcation PCI : The LM V-RESOLVE Score

Kefei Dou, MD Fuwai Hospital, China Managing left main bifurcation lesions has always been one of the most complex challenges in interventional cardiology. These lesions, which account for 5-7% of coronary cases and often involve the distal bifurcation, are associated with high mortality rates. Despite significant advances in treatment strategies, predicting and preventing side branch (SB) occlusion during left main (LM) percutaneous coronary intervention (PCI) remains a pivotal goal. The LM V-RESOLVE score is a new, angiographic-based scoring system developed to predict the risk of SB occlusion in LM bifurcation PCI. It builds on previous versions of the RESOLVE score series, which have been widely recognized for their utility in assessing bifurcation lesion risk. However, the earlier RESOLVE models were limited in their application to LM bifurcations, as less than 5% of the initial development cohorts included these lesion types. The LM V-RESOLVE score was specifically designed to address these gaps, incorporating anatomical differences unique to LM bifurcations. The study behind the LM V-RESOLVE score analyzed a cohort of 855 patients who underwent LM bifurcation PCI with a provisional stenting strategy. After extensive data collection and regression modeling, three key angiographic parameters were identified as predictors of SB occlusion: main vessel (MV) plaque distribution, MV/SB diameter ratio, and SB baseline stenosis. Each factor contributes to the score, with higher values reflecting greater risk. For example, a stenosis rate of 70-90% in the SB adds three points to the score, while a stenosis greater than 90% adds seven points. The LM V-RESOLVE score was validated both internally and externally, showing excellent predictive accuracy with a C-statistic of 0.83. It successfully stratifies lesions into low-risk (score

December 13, 2024 1886

AP VALVES & SH 2024

Beyond COAPT: Shaping the Future of Functional MR Treatment

Takashi Matsumoto, MD (Shonan Kamakura General Hospital, Japan), stressed the benefit of transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (MR), regardless of the acute or chronic disease. The multicenter, randomized, controlled, parallel-group, open-label trial, COAPT (Transcatheter Mitral-Valve Repair in Patients with Heart Failure) trial demonstrated that transcatheter mitral valve repair resulted in lower rates of hospitalization for heart failure (HF) and all-cause mortality within 24 months of follow-up compared with medical therapy alone in patients with moderate to severe or severe secondary MR who remained symptomatic despite maximum guideline-directed medical therapy. Furthermore, this outcome benefit was also showed at 5 years of follow-up. However, the Mitra FR trial, similar with the COAPT trial that confirmed the effect of TEER on MR, did not show a significant reduction in clinical events. There are several reasons for this: differences in the severity of MR and LV remodeling between the two trials, and guideline directed medical therapy was not optimized before procedure and the quality of procedure was not good in Mitra FR trial. Nonetheless, in the landmark analysis of the Mitra FR trial analyzing patients who survived for 1 year without hospitalization for HF, the primary end point was the cumulative number of HF hospitalization at 1 year, and although it was not statistically significant, a clear reduction in the incidence of HF hospitalizations was observed in the device group. And COAPT post-approval study, a prospective, single-arm, observational study, enrolled 5,000 patients in United States, comparing COAPT like patients with Mitra like patients. In both groups, there was a similar and durable reduction of MR and a significant improvement in quality of life at 1year. He presented sub-analysis of EXPANDed Study presented at the New York Valve conference. It evaluated clinical events after MitraClip in moderate or severe MR. In both groups, there was a significant reduction in MR severity, LV reverse remodeling, symptom improvement and significant reduction in HF hospitalization. He emphasized the importance of TEER by presenting a case summary showing how to treat MR in acute decompensated heart failure with acute MR. Although it is still difficult to establish the indication and timing of urgent TEER, he concluded that TEER is a very strong treatment option for this dynamic acute functional MR and can immediately reduce MR with a very high safety profile. Live Case & Lecture 6: Mitral TEER Friday, August 09, 2:00 PM ~ 3:40 PM Main Arena, Vista Hall 1, B2 Check The Session

September 13, 2024 3235

AP VALVES & SH 2024

TAVR in Asia: Optimal TAVR Choice for Asian Patients with Small Annulus, Vessels, and Body Size

At the AP VALVES & SH 2024 conference, Duk-Woo Park, MD, PhD (Asan Medical Center, Korea), highlighted critical considerations for Transcatheter Aortic Valve Replacement (TAVR) in Asian populations, particularly focusing on patients with smaller annuli, vessels, and body sizes. As TAVR becomes increasingly adopted across Asia, the unique anatomical challenges posed by these smaller dimensions demand careful selection of prosthetic valves to optimize patient outcomes. One of the key concerns discussed was the prevalence of small aortic annuli in the Asian population, which occurs in approximately 40% of cases. This anatomical feature is associated with a higher risk of prosthesis-patient mismatch (PPM), where the implanted valve is too small relative to the patient’s body size. This mismatch can lead to increased mechanical stress on the valve leaflets, accelerating structural valve degeneration and reducing long-term durability—a concern particularly pertinent given the growing emphasis on valve longevity in the region. The session also underscored the racial disparities in TAVR outcomes, with Asian patients showing a higher incidence of severe PPM compared to their Western counterparts. This difference emphasizes the need for tailored approaches when treating Asian patients. He noted that while newer generation valves have improved hemodynamic performance, ensuring an optimal fit remains challenging, particularly for high-risk patients and younger, more active individuals. Further insights were provided from the SMART trial, which compared self-expanding valves (SEV) and balloon-expandable valves (BEV) in patients with small aortic annuli. The trial, one of the largest and most rigorous to date, revealed that SEVs offered superior valve performance, including a 32.2% lower incidence of bioprosthetic valve dysfunction and a 5.3% reduction in severe PPM. These findings suggest that SEVs may be particularly advantageous for Asian patients, though the direct applicability of the trial’s results to this population remains a subject of ongoing debate. In conclusion, while advancements in TAVR technology are promising, the conference highlighted the necessity of further research and validation to ensure these innovations translate into improved outcomes for Asian patients with small annuli and other unique anatomical features. Keynote Lectures on TAVR 2024 Friday, August 09, 1:00 PM ~ 2:00 PM Main Arena, Vista Hall 1, B2 Check The Session

September 06, 2024 2727

AP VALVES & SH 2024

15 Years' Journey of AMC TAVR

At the AP VALVE & SH 2024 conference, Seung-Jung Park, MD, PhD (Asan Medical Center, Korea), marked the 15th year anniversary of pioneering Transcatheter Aortic Valve Replacement (TAVR) at AMC. Over this period, AMC has evolved from its initial procedures to becoming a leader in the field, consistently improving outcomes and expanding the range of patients who can benefit from TAVR. Evolution of TAVR Guidelines and Clinical Practice Since the pivotal 2010 PARTNER IB trial, TAVR has gained acceptance as a preferred treatment for patients with severe aortic stenosis, particularly those at high surgical risk. Recent trials, including the SMART trial, have further demonstrated TAVR's benefits in younger, lower-risk populations. The meta-analysis of low-risk TAVR trials involving over 2,000 patients shows that TAVR offers superior one-year mortality rates and cardiovascular outcomes compared to Surgical Aortic Valve Replacement (SAVR). The 2020 ACC/AHA guidelines recommend TAVR as the first-line treatment for patients over 65 years old. While the ESC guidelines suggest TAVR primarily for patients over 75, with individualized assessments for those younger. However, real-world data shows a trend toward using TAVR in younger patients, with 78% of patients under 65 receiving TAVR in 2021-2022. This shift reflects a growing preference for tissue valves over mechanical ones, driven by TAVR's minimally invasive nature and favorable outcomes. AMC's TAVR Success: The Role of Minimalist Approaches and CT Algorithms AMC has now performed over 2,000 TAVR procedures, with a current rate of 300 cases annually. The center boasts a procedural success rate of 99.7%, low complication rates, and excellent one-year outcomes, including an all-cause mortality rate of 7.2% and a disabling stroke rate of less than 1%. This success is attributed to AMC’s heart team collaboration, a minimalist approach to anesthesia and patient care, and the precision of the AMC CT algorithm for device selection. The AMC CT algorithm is a cornerstone of this success, allowing for meticulous pre-TAVR planning. By analyzing factors such as vascular access, aortic annulus size, calcium distribution, and coronary height, the team at AMC ensures optimal device sizing and placement. This approach has led to low rates of paravalvular leak (PVL) and permanent pacemaker implantation, particularly with the use of balloon-expandable devices, which are preferred for their strong radial force and predictable outcomes. AMC continues to adapt its techniques to address complex cases, such as those involving bicuspid aortic valve stenosis, which typically involves higher calcium burdens and more challenging anatomies. In these cases, AMC has successfully applied its refined approaches, resulting in procedural outcomes comparable to those in tricuspid valve cases. In-depth Analysis of the SMART Trial and its Implications on TAVR Practices During the discussion of the SMART trial, particular focus was given to the management of patients with small aortic annuli (less than 430 mm²). The trial compared outcomes between self-expanding and balloon-expandable valves, with the latter using primarily 23mm devices. While both groups had similar clinical profiles, notable differences in procedural characteristics emerged. However, the device success rate was slightly lower compared to self-expanding valves. At AMC, where approximately 40% of patients fit the SMART trial criteria, data showed a high procedural success rate and a significantly lower incidence of paravalvular leak (PVL) compared to the SMART trial. This discrepancy highlights the importance of meticulous device selection and sizing, particularly in patients with small annuli. AMC’s approach, which carefully considers factors like annulus size and calcium load, has proven effective in optimizing outcomes. The differences between AMC’s outcomes and those of the SMART trial underscore the critical role of pre-TAVR planning using CT analysis. The SMART trial's use of relatively undersized devices without adequate consideration of calcium levels likely contributed to higher PVL rates. In contrast, AMC’s tailored approach, guided by detailed MDCT analysis, emphasizes the importance of precise device sizing to prevent complications. Opening, Live Case & Lecture 1: TAVR Thursday, August 08, 1:00 PM ~ 2:20 PM Main Arena, Vista Hall 1, B2 Check The Session

August 30, 2024 2603

AP VALVES & SH 2024

TAVR for Bicuspid AV: What's Different?

At the AP VALVES & SH 2024 conference, Jung-Min Ahn, MD, PhD (Asan Medical Center, Korea), delivered important findings on the challenges and outcomes of Transcatheter Aortic Valve Replacement (TAVR) in bicuspid aortic valve (BAV) patients. Despite the anatomical complexities of BAV, the data from Asan Medical Center suggest that TAVR can be performed as safely and effectively as in tricuspid aortic valve (TAV) patients, albeit with some unique procedural considerations. Between 2016 and 2023, Asan Medical Center conducted TAVR on approximately 1,000 patients using the Sapien 3 valve system, with 124 of these patients having BAV (Figure 1). They found that BAV patients were generally younger (mean age 77), predominantly male, and had fewer comorbidities compared to those with TAV. Echocardiographic findings indicated more severe aortic valve stenosis in BAV patients, with higher transaortic pressure gradients and more significant calcification, as evidenced by higher calcium volumes (Figure 2). Figure 1 Figure 2 Procedurally, BAV cases required larger transcatheter heart valves (THVs) and more frequent pre- and post-dilation. Notably, in BAV patients with heavy calcification, the strategy leaned toward less valve oversizing to reduce procedural risks (Figure 3). While the rates of pacemaker implantation and paravalvular leak were slightly higher in BAV patients, these differences were not statistically significant. Long-term outcomes showed no significant differences in mortality or stroke rates between BAV and TAV patients up to two years after the procedure (Figure 4, 5). Figure 3 Figure 4 Figure 5 He emphasized the need for developing specific criteria, similar to the Echo-Score used in rheumatic mitral stenosis, to better identify BAV patients who are ideal candidates for TAVR. This could further enhance procedural success and patient outcomes in this complex patient group. Live Case & Lecture 2: Bicuspid, Mitral TEER Thursday, August 08, 2:30 PM ~ 4:10 PM Main Arena, Vista Hall 1, B2 Check The Session

August 30, 2024 2108

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