RTHahnMD

Finally able to treat our Symptomatic AR patients!! @HeartValveCntr @Columbia @JenaValve @ACCinTouch @escardio

@Edgar__K @ESCardioNews @ESC_Journals @escardio @ACCinTouch @juliendreyfus1 @FabienPraz @NAjmoneMarsan @denisamuraru But if a Heart Team capable of integrating all findings can use all parameters to assess true severity and possible benefit, why wouldn’t that be a win for our patients?

This table perfectly maps an O(n) procedural gridlock. 🛑 ​Standardizing biological chaos by stacking endless 'requirements' only increases system latency. In a critical biological system, administrative latency equals thermodynamic loss for the patient. ​The goal shouldn't be to build a bigger, heavier maze of checklists (the M-Tensor) to justify an intervention. The goal is to collapse it. The physician (the H-Oracle) needs an architecture that allows for O(1) execution, bypassing the infinite validation loops. ​We must use data to prune the bureaucratic noise, not just to organize it. The baseline is survival, not compliance. M ⊗ H = 1. 🧠⚡⚖️⚙️✨

Just published bit.ly/TR-Standard_WU Hoping to standardize identification of appropriate patients for TTVI! @ESCardioNews @ESC_Journals @escardio @ACCinTouch @juliendreyfus1 @FabienPraz @NAjmoneMarsan @denisamuraru

Presented at #ACC26: In patients with atrial fibrillation, left atrial appendage closure was noninferior to NOACs in an analysis of death from cardiovascular causes, stroke, or systemic embolism and was superior for non–procedure-related bleeding. Full CHAMPION-AF trial results: nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Should Recommendations Be Expanded? nejm.org/doi/full/10.10… @ACCinTouch

#acc26 Six reasons why CHAMPION AF should not change oral anticoagulation for AF I will have a formal post up on @theheartorg but here is a short summary 1) Stroke and Ischemic Stroke went the wrong way. All S -> 33 vs 50 [HR 1.46 95% CI, 0.94-2.27)] IS -> 27 vs 45; [HR = 1.61; 95% CI, 1.00-2.59)] Look at those upper-bounds. 2) NI would not have been met for efficacy had they used a margin with both rate ratio and risk difference, which is standard practice. The margin of 4.8% is based on event rates at 12%, which is 1.4 in relative terms (40% higher). But when event rates come in lower, as they did: 4.8% vs 5.7%, the 4.8% margin is too lenient. The 0.9% higher rate of the primary endpoint has a 95% CI of (-0.8-2.6%), so 2.6% is less than the margin of 4.8%. Now do it with relative risk. It's in table 2. The relative risk is 1.20. The 95% confidence intervals were 0.87-1.66. Note that 1.66> 1.40 so LAAC is not noninferior based on rate ratio margins 3) The primary safety endpoint is flawed because it excludes periprocedural bleeding and uses nonmajor bleeds, such as gum bleeds and bruising. It's open label trial so who which group will complain of more nonmajor bleeding? 4) When counting all events, Watchman barely reduced major bleeds. Also in the main results table is that major bleeds were 83 vs 87 (5.5% vs 5.8%; HR 0.92 95% CI 0.68-1.24) 5) Net Clinical Benefit was also flawed because they used nonprocedural bleeding and nonmajor bleeds. A normal patient would simply say, there were 17 more strokes and only 4 less bleeds. Hardly a good trade. 6) Bayes: trials don't give answers, they update priors. For Watchman, you have PREVAIL failing against warfarin, CLOSURE AF clearly failing against best med Rx (mostly DOACs) so priors are pessimistic. To go from pessimistic priors to enthusiastic posteriors you'd need hugely positive data. CHAMPION is not that. Don't believe the stories that CLOSURE failed due to them using other LAAC devices. In the AMULET IDE trial, Watchman and Amulet were similar. Also, if you believe that German operators are worse than US authors, you need to travel more. Conclusion: Oral anticoagulation for AF is one of the most evidence-based practices in all of medicine. To upend that would take much stronger data. Don't be bamboozled by this trial, which was designed to be positive before the first patient was enrolled. #ACC2026

JUST PUBLISHED @JACCJournals bit.ly/EuroTRScore See Online score EuroTR.eu Congrats @j_hausleiter @JennifervStein @KP_Kresoja @PhilippLurz @MariannaAdamo1 @Sticchi_Alex @JGrapsa @MarcoMetra @escardio @ACCinTouch

JACC just published 6yr outcomes from the Evolut Low Risk Trial w/additional 7yr follow-up. 1° endpoint (death or disabling stroke): no difference through 6 years. Imp finding: A divergence in reintervention appears beyond year five. @JACCJournals jacc.org/doi/10.1016/j.…

bit.ly/6yrLowRiskEvol… online. Interesting findings of ⬆️ reintervention in TAVR (vs SAVR) with longer-term follow-up. Editorials give excellent perspectives on the findings. @JACCJournals @ACCinTouch @ESC_Journals @escardio @GilbertTangMD @iamritu @purviparwani

Join us in room SYDNEY at @TokyoValve @PCRonline Starting now!!!

New Balloon-Expandable Valve! #DURAVR bit.ly/DURAVR_SmallAnn Changing the discussion of Small annulus AS? @EuroInterventio #EuroPCR @EAPCIPresident @escardio @ACCinTouch

Sex Diff's in LV remodeling w/ Aortic Regurgitation bit.ly/4rezT8D Echo Volumes are key, but could we screen with linear dimensions? bit.ly/LVChamberTTEvs… bit.ly/LVChamberTTEvs… @JAMA_current @JAMACardio @NAjmoneMarsan @ACCinTouch @escardio

Two of our @Columbia @HeartValveCntr studies led by Robin LeRUZ made the impactful #tricuspid regurgitation papers list by PCR!! Great overview by @PCRonline! @JACCJournals @ACCinTouch @escardio @Europace

@JACCJournals BEST OF JACC: CVImg 2006 bit.ly/4pAQAdf. Our TR review TR made it!!! bit.ly/DecadeTR @lpbadano @denisamuraru @FabienPraz @NAjmoneMarsan @joan_bartc @VDelgadoGarcia @juliendreyfus1 @j_hausleiter @PhilippLurz @drmaisano @JoaoLCavalcante @ACCinTouch @escardio

DeviceGuide: AI tool for M-TEER Guidance! See the JACC Case Series authors.elsevier.com/sd/article/S26… @JACCJournals @GilbertTangMD @ACCinTouch @escardio

Great MMI session on AS Evaluation #EACVI2025 See highlights below. @escardio @EACVIPresident

50 days' free access: Cardiac Remodeling after TTVR: Insights from Multi-modality Imaging: authors.elsevier.com/a/1mA9y6uPJvyN… CONGRATS Robin Le Ruz @JACCJournals @escardio @ACCinTouch

Join us now at the Philips Training Village for discussion of advances in Imaging for Structural Heart #PCRLV @PCRonline

Just presented: PARTNER 3 Low-risk Randomized Trial Valve Durability at Seven Years @PCRonline #PCRLV @PPibarot @ACCinTouch @escardio

PREVUE-VALVE Novel approach to pt recruitment! VHD projected to increase by nearly 4 million by 2060--TR prevalence highest (10.7% of pts with significant VHD)!! @djc795 @BrenerMickey @ACCinTouch @escardio @TCTMD @TCTConference

Just presented @TCTConference EuroTR Score!! More to learn about risk assessment! @j_hausleiter @ACCinTouch @escardio @TCTMD @purviparwani @ritu