TAVR Bot

I will quote tweet if you mention me in your tweet. @TAVRBot #TAVR. Created by @willsuh76

[TAVR Bot @TAVRBot]

Elon Musk tried to kill me but @willsuh76 did Twitter CABG to achieve ROSC.

New protocol. Mention me and use #TAVR and I will quote tweet you.

Example 👇
I ❤️ #TAVR @TAVRBot

[William Suh, MD @willsuh76]

Severe AS can progress rapidly & unpredictably from asymp. to advanced symptoms. Age/biomarkers/cardiac damage/LV health can’t predict its outcome. I’m teaming up w/ @EdwardsLifesci to get the word out: Prompt referral upon diagnosis can be lifesaving—regardless of pts’ symptoms.

[William Suh, MD @willsuh76]

~40% of asymp. severe AS patients progress to advanced symptoms (acute valve syndrome) & face higher risks of death, stroke, or HF 🏥. The challenge? Predicting who will. I’m teaming up w/ @EdwardsLifesci to encourage early referral to a Heart Valve Team before symptoms escalate.

[MIЯVΛƬ #IC ༄ ｡° @mirvatalasnag]

86M severe AS & Prior stroke
BEV platform & procedure time < 30minutes

If risk of stroke is high, what are your technical tips? (Let’s put the EPD discussion to rest for now)
❓should we avoid multiple inflations
❓does the THV platform make a difference

@TAVRBot @tavrkapadia @djc795 @AliSahebHusain @almoghairi @HatimLawati @AlhijjiM @fjsawaya @SSamargandy @yaqoub_lina @kalazizimd @AnasNomanMD @drptca @AlkashkariWail @TCT_ME_

[William Suh, MD @willsuh76]

#TAVR poll

Patient had SAVR 10 years ago. Echo now shows AVA 0.5 cm2, MG 35 mmHg, Vmax 3.9 m/s, SVI 21 ml/m2, moderate AR.
Patient has no symptoms.
What next?

[megan coylewright md mph @MCoylewright]

When's the right time to talk with aortic stenosis (AS) patients about treatment options and goals? Patients are ready earlier than HCPs expect. I’m collaborating with @EdwardsLifeSci on ways the Informed Decision Guide can help you start the conversation. https://t.co/Me9tXm4ddm

[William Suh, MD @willsuh76]

#TAVR poll

I like seeing patients with moderate aortic stenosis to explain diagnosis, natural history and surveillance. Also to develop a relationship with patient

When do you like to see patients with aortic stenosis?

[William Suh, MD @willsuh76]

#TAVR Bumper Technique

This visual shows how this technique works.

Without bumper, the leading edge of the THV stent can catch a lip of calcium.

With bumper, the 🎈bulges over the leading edge and protects it from catching calcium. Also prevents scraping in aorta.

[William Suh, MD @willsuh76]

#TAVR Bumper Technique

This is something I’ve been doing and it makes crossing the aortic valve easy without pre BAV.

After final valve assembly in descending aorta, roll contrast into the nose cone to create the bumper.

1. Reduces scraping in aorta.
2. Crosses like butter!

[João Cavalcante @JoaoLCavalcante]

Treat the valve AND the myocardium when facing severe AS+amyloidosis. Both AVR and tafamidis independently ↓ mortality
Dual therapy=best outcomes w/ similar survival to lone AS+AVR. Dual pathology is common (~13%) warranting RCT. https://t.co/q1wqnZSlZV Bravo @ThomasTreibel! 👏🏻

[William Suh, MD @willsuh76]

Are we officially changing US nomenclature from #TAVR ➡️ #TAVI

[William Suh, MD @willsuh76]

#TAVR poll
Patient with TAVR 11 years ago, S3 26 mm, MG 41 mmHg.
CT shows HALT, leaflets no calcification.
What is your anticoagulant of choice?

[CircInterventions @CircIntv]

Is transcarotid TAVR a suitable alternative to SAVR in unsuitable transfemoral access? Transcarotid versus surgical aortic valve replacement for severe AS @MAvvedimento @delportilloJH @sidmengi_dr @pedro_cepas #AHAJournals https://t.co/6pjEmkZFes

[William Suh, MD @willsuh76]

#TAVR poll

Where is the cardiac surgeon during TAVR?

[William Suh, MD @willsuh76]

@djc795 What would it take for TVT registry to be opened? Both @Edwards_TAVR and @MDT_StructHeart would have to agree?

@ACCinTouch @STS_CTsurgery

[William Suh, MD @willsuh76]

Death is an undeniable hard outcome.
#TAVR trials suggest that outcomes between BEV and SEV are similar.
But look at MAUDE database. Search 7/1/24 - 12/31/24, outcome death.
Edwards SAPIEN = 22 records
Medtronic Evolut = 228 records
10-fold higher with Evolut 😳
Why?

[Mayra Guerrero, MD @MayraGuerreroMD]

Exactly 20 years ago, the 1st TAVR in the US was done by Dr William O’Neill at William Beaumont Hospital! Dr. Alain Cribier was the proctor. I was an interventional fellow watching from the control room. Those 5 seconds when I saw the valve being deployed, literally changed my life. It was like “I saw the future”. I knew then that I would dedicate the rest of my career to transcatheter valvular interventions. Thank you Dr. O’Neill and Dr. Cribier 🙏 for giving me the opportunity of witnessing history being made!!! 😃And for being such great mentors and role models!!! 🙏❤️ @MayoClinicCV

[William Suh, MD @willsuh76]

For those that do mitral TEER, which device do you prefer and why?

#CardioTwitter #Structural
#MitralRegurgitation #TMVR

[William Suh, MD @willsuh76]

#TAVR
1 yr safety outcomes from ACURATE IDE Trial
RCT - Acurate vs Evolut vs SAPIEN
S3 had lower CV death, disabling stroke and PVL compared to other 2 devices.

For years, we have been asking for comparative data from TVT registry. Where is the transparency? Time to open it up!

[William Suh, MD @willsuh76]

#TBT #TAVR #CardioTwitter
Second generation @Edwards_TAVR SAPIEN XT
18F sheath, double Perclose
Still doing general anesthesia, Swan, TEE
Didn't go to conscious sedation TAVR until SAPIEN3
#TAVREvolution

[William Suh, MD @willsuh76]

#TBT #TAVR #CardioTwitter
Original @Edwards_TAVR SAPIEN valve
22F sheath, femoral cut down
General anesthesia, Swan, TEE
#TAVREvolution