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TCTAP 2025

AI in Coronary Imaging: On the Brink of Mainstream Adoption

Artificial intelligence (AI) is rapidly redefining the landscape of cardiovascular medicine, particularly in coronary imaging. As it evolves from a niche innovation to a potentially mainstream tool, its role in enhancing image acquisition, interpretation, and individualized treatment planning continues to expand. In an upcoming session at TCTAP 2025 titled "AI in Coronary Imaging: Mainstream or a Niche Research Tool?" Bon-Kwon Koo, MD, PhD (Seoul National University Hospital, Korea), will provide insight into the transformative impact of AI on invasive and non-invasive coronary imaging modalities. In recent years, AI—especially through machine learning (ML) and deep learning (DL)—has emerged as a critical adjunct in coronary imaging. Its applications span multiple domains, from optimizing image quality to automating lesion assessment and even simulating physiology from image data. AI's integration into imaging workflows has become mainstream in several aspects, such as artifact reduction and automated segmentation. A notable example of AI's clinical utility is seen in the EMERALD II study, where AI-enabled Quantitative Coronary Plaque and Hemodynamic Analysis (AI-QCPHA) demonstrated superior predictive value for future acute coronary syndromes compared to conventional imaging analysis (Figure 1). Figure 1. Such tools offer clinicians improved risk stratification and data-driven support for treatment decisions. Another emerging application is the use of explainable machine learning methods that analyze lesion-specific data, enabling precision risk prediction and tailored treatment strategies for individual patients. Figure 2. However, despite these encouraging advancements, several challenges persist before AI can be fully integrated into everyday clinical practice. AI models depend heavily on large, diverse, and high-quality datasets. Their generalizability across different patient populations and imaging protocols remains a concern. Furthermore, the lack of standardization and the complexity of regulatory pathways pose significant hurdles. Prospective validation in multicenter, real-world settings is critical. Moreover, achieving regulatory clarity and developing user-friendly interfaces will determine how quickly and effectively AI can transition from academic research to routine bedside use. He emphasizes the importance of cross-disciplinary collaboration—among clinicians, engineers, and regulatory agencies—to guide the responsible deployment of AI in coronary imaging. He notes that with ongoing validation studies and regulatory adaptation, AI is poised to become an indispensable adjunct in cardiovascular diagnostics. As this technological frontier advances, TCTAP 2025 attendees will gain valuable foresight into the promise and limitations of AI in coronary imaging and how it might soon shape the future of cardiovascular care. MedTech Innovation Thursday, April 24, 3:20 PM - 4:30 PM Valve & Endovascular Theater, Level 1 Check The Session

April 24, 2025 622

TCTAP 2025

DM and Three-Vessel Disease: Why We Need New RCTS- DEFINE-DM Trial

At TCTAP 2025, Duk-Woo Park, MD, PhD (Asan Medical Center, Korea), will present an important lecture titled “DM and Three-Vessel Disease: Why We Need New RCTs-DEFINE-DM Trial.” His presentation will highlight a bold initiative to redefine the revascularization strategy for diabetic patients with multivessel coronary artery disease (CAD) through a rigorously designed trial incorporating contemporary interventional advances. Why DEFINE-DM Is Needed For decades, landmark trials such as FREEDOM, BARI 2D, SYNTAX, and BEST have consistently supported coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and multivessel CAD. However, most of these studies were limited by outdated technologies-first generation drug-eluting stents (DES), minimal use of physiologic or intravascular imaging guidance, and lack of contemporary guideline-directed medical therapy (GDMT). He will emphasize that the evolution in interventional cardiology now demands a reassessment. With second generation DES, widespread use of IVUS/OCT and FFR/iFR, and robust cardiovascular and antidiabetic therapies—including SGLT2 inhibitors and GLP-1 receptor agonists—the treatment landscape has transformed. DEFINE-DM will aim to answer whether modern PCI can now stand shoulder to shoulder with CABG in diabetic patients with complex coronary disease. Trial Design and Objectives The DEFINE-DM (Diabetes-Centered Evaluation of Revascularization Strategy of Functional and Imaging-CombiNEd State-of-the-Art Percutaneous Coronary Intervention or Coronary-Artery Bypass Grafting in Patients with Diabetes Mellitus and Multivessel Coronary Artery Disease) trial will be a multicenter, international, randomized controlled trial, powered to test the non-inferiority of PCI compared with CABG. 1,360 patients with T2DM and angiographically confirmed three-vessel CAD (≥50% stenosis in all three major epicardial arteries) will be enrolled, excluding those with left main disease. Patients will be randomized in a 1:1 fashion to either modern PCI or standard CABG, with revascularization decisions made by an independent heart team. The primary endpoint will be a composite of all-cause death, myocardial infarction (MI), or stroke at 2 years. Secondary endpoints will include each component of the primary composite outcome, a composite of death or MI, a composite of death, MI, stroke or repeat revascularization, stent thrombosis, symptomatic graft occlusion or stenosis, bleeding events, and patient-reported outcomes, including quality of life and angina class. Interventions in Each Arm In the PCI arm, lesion selection will be guided by FFR (≤0.80), or adverse imaging features and all procedures will require post-stent optimization using IVUS or OCT. Only second-generation DES will be used. In the CABG arm, surgery will be performed within 30 days of randomization, with internal mammary artery grafting to the LAD and complete revascularization strongly encouraged. He will highlight the strict standardization of procedures across both arms and the protocol’s insistence on contemporary medical therapy. Endocrinology consultations during hospitalization and follow-up will be implemented to ensure optimized diabetic care, including the recommended use of SGLT2 inhibitors or GLP-1 RAs. Eligibility Criteria Participants must be ≥20 years old, have established T2DM, and be deemed suitable for PCI and CABG. Key exclusion criteria will include left main disease, STEMI within 5 days, EF

April 24, 2025 529

TCTAP 2025

Redo-TAVR From Planning to Execution: Tips and Tricks

At TCTAP 2025, Gilbert H. L. Tang, MD (Mount Sinai Health System, USA), will present a comprehensive framework to streamline Redo-TAVR procedures through simplified planning and standardized technical execution. As the number of patients receiving transcatheter aortic valve replacement (TAVR) increases, the need for effective and reproducible strategies for Redo-TAVR becomes crucial, especially in lifetime valve management. In his talk, titled "Redo-TAVR From Planning to Execution: Tips and Tricks," he will share a practical approach that enables operators to safely navigate various TAV-in-TAV scenarios while maintaining optimal hemodynamic outcomes and ensuring coronary access. He will begin by categorizing Redo-TAVR procedures based on the interaction between the index and the second transcatheter heart valve (THV). The four possible combinations include: Short-in-Short, Short-in-Tall, Tall-in-Short, and Tall-in-Tall. This classification sets the stage for further procedural planning by determining the anatomical interaction and associated risks. By simplifying these into two scenarios based on the design of the second valve (TAV #2 – short or tall), he will guide the audience through tailored decision-making pathways. Each combination presents unique challenges related to valve positioning, coronary risk, and THV expansion. The planning process will start with a detailed evaluation of four key anatomical and procedural concepts. First, understanding the fluoroscopic markers and structural landmarks of the existing valve is essential for the successful positioning of TAV #2. Second, the neo-skirt plane (NSP), which represents the new functional skirt level after redo, is determined by the commissural post of the index valve (for tall TAV #2) or the outflow level of TAV #2 (for short TAV #2). Third, the coronary risk plane (CRP), the lowest margin of the coronary orifice, sets the lower boundary of the coronary risk zone (CRZ). Lastly, he will emphasize evaluating the CRZ by measuring the virtual to annulus (VTA) distance, which should ideally be greater than 4 mm to minimize obstruction risk. These concepts will be visualized using frame alignment views on fluoroscopy, offering an intuitive method to identify NSP and CRP for optimal TAV #2 implantation. He will then outline a procedural strategy that translates anatomical insights into actionable techniques, beginning with identifying the index TAV and evaluating the CRZ. Next, he will focus on determining the appropriate implant position for TAV #2, which will depend on its design and the anatomical environment. Pre-dilatation of the index TAV will be highlighted as a critical step, especially in underexpanded or stenotic valves, to optimize the seating of TAV #2 and reduce the risk of HALT. During the implantation of TAV #2, he will recommend slow and controlled deployment to maintain coaxiality and avoid unintended valve movement, particularly in short-in-short or short-in-tall configurations. Post-dilatation will be the final optimization step to ensure adequate expansion of TAV #2, minimize perivalvular leak, and improve overall hemodynamic performance. Throughout the presentation, he will illustrate real-world case examples involving valve pairs, such as SAPIEN 3 Ultra RESILIA, in Evolut PRO or Navitor Vision. He will highlight the importance of coaxial alignment, stiff wire manipulation, and the role of coronary protection in borderline CRZ measurements, such as those with VTA between 2 and 4 mm. He will stress that post-dilatation alone cannot correct underexpanded index valves, reinforcing the importance of aggressive pre-dilatation to optimize long-term outcomes. The proposed Redo-TAVR strategy will also emphasize the value of standardization. With pamobile tools such as the "Redo TAV" app (developed by Vinnie Bapat, Miho Fukui, et al.), operators can access procedural checklists and visualize anatomical landmarks in real-time. By demystifying the Redo-TAVR workflow, he aims to provide a reproducible roadmap that reduces variability in outcomes while ensuring safety across complex anatomical subsets. He will conclude by emphasizing that Redo-TAVR can be simplified through structured planning and meticulous execution. Frame alignment fluoroscopy will be critical to determine NSP and CRP. Pre-dilatation will remain essential for procedural success and long-term valve durability. Positioning of TAV #2 should prioritize coaxiality and depth control, while slow inflation during deployment will reduce the risk of valve migration and coronary obstruction. As Redo-TAVR becomes a more frequent necessity in lifetime valve care, his approach is expected to shape procedural standards and provide clarity for interventional cardiologists navigating this evolving field. Figure 1. NSP and CRZ Evaluation with Frame Alignment View TAVR: Key Issues in 2025 Thursday, April 24, 8:10 AM-9:50 AM Valve & Endovascular Theater, Level 1 Check The Session

April 24, 2025 632

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 511

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 533

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 15756

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 3208

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 3158

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 2114

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 3460