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.

Join us in an enlightening conversation hosted by Dr. Steven Yakubov with Dr. Guilherme Attizzani, the director of the Structural Heart Program at University Hospitals in Cleveland, Ohio, and a professor of medicine at Case Western Reserve School of Medicine. Dr. Attizanni shares his inspiring journey from Brazil to becoming a leading figure in cardiology. Discover how his unique experiences and dedication have shaped his approach to post-tab coronary access and lifetime management.

In this episode, Dr. Attizzani discusses his strategic efforts to build a successful structural heart program, overcome challenges, and foster relationships with referring physicians. He highlights the importance of creating a concierge service for patients and referring doctors and emphasizes the vital role of nurse navigators in delivering exceptional care.

Dive into Dr. Attizzani's groundbreaking academic pursuits, including his work on coronary access post-TAVR implantation and innovative strategies for the lifetime management of aortic valve patients. Learn about his involvement in pivotal clinical trials and his contributions to optimizing resources and procedures in interventional cardiology.

Explore the future of aortic valve interventions as Dr. Attizzani shares his vision for enhancing coronary access, customizing procedures, and addressing the challenges of TAV-IN-TAV interventions. This episode offers valuable insights for medical professionals and anyone interested in the advancements shaping the field of cardiology.

Join Dr. Puja Parikh, Director of the TAVR program at Stony Brook University Hospital, as she hosts a captivating conversation with the renowned cardiac surgeon Dr. Michael Reardon. Dr. Reardon, a leader in cardiac surgery and structural heart innovation, shares his remarkable journey into the field, from an unexpected childhood incident to becoming a pivotal figure in the transcatheter aortic valve replacement (TAVR) revolution.

In this insightful episode, Dr. Reardon reflects on the evolution of cardiac surgery training and the transformative impact of TAVR. He discusses the importance of adapting to new technologies, the future of cardiac surgery education, and the potential challenges and opportunities facing young surgeons today. The conversation also delves into the role of AI in patient care and the ongoing advancements in valve technologies.

Dr. Reardon offers invaluable advice to early-career colleagues and trainees, emphasizing the importance of open-mindedness, hands-on experience, and collaboration between cardiologists and surgeons. This episode is a must-listen for anyone interested in the future of cardiac care and the dynamic world of structural heart interventions.

In this episode of the Structural Heart podcast, world-renowned cardiothoracic surgeons Dr. Patrick McCarthy and Dr. Dan O'Hair discuss a wide range of topics centered around advancing technology within the surgical and structural heart landscape. The episode starts with Dr. McCarthy and Dr. O'Hair discussing emerging surgical mitral technology alongside how lulls in procedures associated with the COVID-19 pandemic afforded them the extra time to analyze their own program data and better understand which patients benefited most from various cardiac therapies. Next, the conversation shifts from mitral to aortic as they discuss consistent themes and fundamentals that are shared between open-heart aortic valve replacements and transcatheter aortic valve replacements. Both physicians speak to the importance of practicing evidence-based medicine within the cardiovascular space and making decisions rooted in data regarding critical procedures like valve replacements. The episode concludes with light-hearted conversation lessons they wish they had learned earlier in their careers and want to pass along to an emerging generation of cardiovascular physicians.

Join us for an exciting discussion led by Dr Hemal Gada, an Interventional Cardiologist from UPMC,Pennsylvania, and Dr. Gilbert Tang, a Cardiac Surgeon from Mount Sinai in NY. The conversation will explore how the evolving TAVR landscape shapes Aortic Stenosis interventions. From the early days to the present, a significant number of patients have been treated, generating a wealth of data on efficiencies, PVL, Hemodynamic impact, and clinical results. What will the data reveal? Will we see a 'TAVR Tsunami' of patients or a more gradual increase in returning patients? Are there any predictors that can help us identify the right patient? What role does Neosinus flow and thrombosis play in this context? Does valve selection influence future events? How do new generations of self-expanding valves influence clinical results? This is an opportunity to analyze mid-long-term data and explore these crucial topics. What do we know about explant TAVR? These are just a few crucial topics explored in this upcoming edition of the Structural Heart Podcast. We invite you to join us for a deep dive into these issues in TAVR and Aortic Stenosis interventions.

Don't miss this crucial episode of the Structural Heart Podcast, where we dive into the SMART trial data and evaluate it from two perspectives. We're honored to be joined by cardiothoracic surgeon Dr. Dan O'Hair and one of the SMART trial's PIs, Dr. Hemal Gada. This discussion is not just about the Evolut and Sapien valve platforms but also about what this data means for patients. Stay tuned as they share their critical interpretations of the SMART Trial.