This podcast episode features our host, Dr. Kendra Grubb, conversing with our guest, Dr. Ashok Seth, a renowned interventional cardiologist. Dr. Seth discusses his pioneering work introducing TAVR and other interventional technology to India and Asia over the past 30 years. Dr. Seth performed the first TAVR CoreValve self-expandable in India in 2004, marking a significant milestone in interventional cardiology. Social attitudes and a lack of reimbursement are additional barriers to TAVI adoption among the elderly in India; India has a unique patient population with more bicuspid cases and smaller annuli, which influences valve choice during procedures. Dr. Seth emphasizes tailoring valve selection to patient anatomy and lifetime management needs. The podcast also touches on the future of structural heart interventions, with Dr. Seth expressing excitement about advancements in mitral and tricuspid valve technologies. Dr. Seth advises emerging TAVI programs to focus on robust systems, standardized protocols, and a hub-and-spoke model for safe and effective outcomes.

Featured faculty: Martha Gulati, MD MS FACC FAHA FASPC FESC Director of Preventive Cardiology and Professor of Cardiology, Cedars Sinai Smidt Heart Institute Associate Director, Barbra Streisand Women’s Heart Center Associate Director, Preventive and Cardiac Rehabilitation Center Anita Dann Friedman Endowed Chair in Women’s Cardiovascular Medicine & Research Roxana Mehran, MD, FACC, FESC, FAHA, MSCAI Director, Women's Heart and Vascular Center at Mount Sinai Fuster Heart Hospital Director, The Center for Interventional Cardiovascular Research and Clinical Trials Professor of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai

Disclosures:

Faculty for this event are consultants for Medtronic and compensated for this event.

Dr. Gulati: I serve on advisory boards for Novartis, Esperion, New Amsterdam and Medtronic. I serve on a DSMB for Merck. All except Medtronic unrelated to our discussion

Dr. Mehran reports institutional research payments from: Abbott, Alleviant Medical, Beth Israel Deaconess Medical Center, Concept Medical, Cordis, Elixir Medical, Faraday Pharmaceuticals, Idorsia Pharmaceuticals, Janssen, MedAlliance, Mediasphere Medical, Medtronic, Novartis, Protembis GmbH, RM Global Bioaccess Fund Management, Sanofi US Services, Inc. ; Personal fees from: Elixir Medical, IQVIA, Medtronic, Medscape/WebMD Global, NovoNordisk ; Equity <1% in: Elixir Medical, Stel, ControlRad (spouse) ; No Fees from: SCAI (Women in Innovations Committee Member), Faculty Cardiovascular Research Foundation (CRF), Women as One (Founding Director) ; Honorarium: AMA - JAMA Cardiology (Associate Editor), ACC (BOT Member, SC Member CTR Program)

TAVR risks may include, but are not limited to, death, stroke, damage to the

arteries, bleeding, and need for permanent pacemaker. †Evolut™ TAVR is indicated to treat patients who have been diagnosed with symptomatic severe aortic stenosis. 1. Tchétché D, Mehran R, Blackman DJ, et al. Transcatheter Aortic Valve Implantation by Valve Type in Women With Small Annuli: Results From the SMART Randomized Clinical Trial. JAMA Cardiol. Published online October 9, 2024.

The Medtronic CoreValve™ Evolut™ R, Evolut™ PRO+, and Evolut™ FX Systems are indicated for relief of aortic stenosis in patients with symptomatic heart disease due to severe native calcific aortic stenosis who are judged by a heart team, including a cardiac surgeon, to be appropriate for the transcatheter heart valve replacement therapy.

The Medtronic CoreValve Evolut R, Evolut PRO+, and Evolut FX Systems are indicated for use in patients with symptomatic heart disease due to failure (stenosed, insufficient, or combined) of a surgical bioprosthetic aortic valve who are judged by a heart team, including a cardiac surgeon, to be at high or greater risk for open surgical therapy (e.g., STS predicted risk of operative mortality score ≥ 8% or at a ≥ 15% risk of mortality at 30 days).

In this episode Dr. Srinivas Iyengar and Dr. Kasi Ramanathan will discuss their own patient and device experiences as they relate to the evolution of Transcatheter Aortic Valve Replacement (TAVR). They review how different valves are designed and how leaflet positioning and frame attachment points are proving to impact the durability and longevity of the different transcatheter valve types differently. The physicians discuss how their perspectives have evolved with new patient indications, transitioning from an initial ‘one TAVR fits all’ mindset to their current perspective of ‘appreciating the nuances of valve durability and patient selection. Especially as it relates to providing long term success and freedom from reintervention for their lower risk and more active patients. Finally, Dr. Iyengar discusses an emerging hot topic within the TAVR community - the physiology and impact of the Neosinus created by the different TAVR designs. Listen as he dissects what the neosinus is, how it differs between valves, and what role it plays in facilitating a transcatheter valve’s circularity and durability after it has been implanted inside of an elliptical aortic annulus.