Honored to be selected as the inaugural fellow for the Mayo Clinic - Cardiovascular Research Foundation Innovation Mentorship Program. Grateful for @adnanalkhouli and @jgranadacrf for the opportunity to learn from leaders in MedTech innovation🫀 @MayoClinicCV @crfheart

‼️Check out our BiV #PVLoop analysis of #Impella 5.5 in a porcine model of AMI-CS 🐷🫀 ⭐️Interventricular dependence ⭐️Improved RV systolic response with higher levels of support ➡️ attenuated post MI doi.org/10.1161/JAHA.125.047…

I heard so many horror stories of fractured wires and trapped burrs that I play two steps ahead and prevent those issues: - Change burr after ~4 min of drilling - Move wire during ablation every 30 seconds - Change wire after 5-6 min of drilling With these measures, I never had any rota-induced perforation or burr entrapment that I couldn't solve by just pulling the wire.

1/2 Our updated meta-analysis of intravascular imaging guidance publ in JACC. Since our last synthesis in Lancet 2024, there have been 6 new RCTs with 8,670 additional pts. Total is now 28 RCTs with 24,634 patients with mean FU 22 mos. Should be enough for a definitive answer!

Clopidogrel vs Aspirin According to Diabetes Mellitus: A Prespecified Analysis of the SMART-CHOICE 3 Trial: @JACCJournals 🥸 Plavix only as monotherapy in patients with DM: SMART-CHOICE 3 😱 Nice paper in JACC Interv 👇👇👇👇

The Rise of the Solo TAVR Operator: Alone, Unarmed, and Unafraid sciencedirect.com/science/ar… Written before CMS finalized its new TAVR NCD - I think CMS got some of it right, and one big thing wrong. Braasch et al looked at 400K Medicare TAVRs, 2016 to 2024. Surgical bailout in 0.56%, falling from 0.92% to 0.40%. Hospital SAVR volume, whether low, intermediate, or high, was not associated with mortality among patients requiring salvage surgery. The absence of an on-site surgeon is not the absence of rescue. Transfer systems exist. A growing share of catastrophic complications, including contained annular injury, tamponade, and device embolization, are now rescued in the cath lab, far from the OR. We have run this experiment before - PCI required on-site surgery on the same theory. CPORT-E: over 18k patients, 6-week mortality 0.9% vs 0.8%. MASS COMM: emergency surgery in 0.1% to 0.3%. PCI without on-site surgery became standard. Systems of care exists across the spectrum of CV care: cardiogenic shock, PE care etc. What CMS got right in the final NCD: TAVR may be performed by a single operator. The mandated dual-specialty evaluation is dropped and only the operator's visit is required. Hospital procedural volume requirements are removed. Asymptomatic severe AS is now covered under CED. Where CMS got it wrong: on-site cardiac surgery is retained. It compels the backup that is so rarely needed. A system of care with straightforward TAVRs being performed by ICs in non-surgical sites with affiliations for complex/transfers would've balanced access. However, CMS & cardiac societies chose politics over patients in the end. Proof: no requirement for on-site EP, though permanent pacing is the most common service after TAVR. No requirement for vascular surgery - much more valuable to a TAVR operator than CV surgery. The mandate is kept to protect physicians not patients. Morevover, medicare imposes no minimum-volume condition on SAVR, despite a median annual surgeon volume of 16 cases. Volume, staffing and heart team requirements get framed as safeguards of quality. But they are absent for the surgical equivalent. Let's be honest - that framing is a pretext for protecting case volume, referral patterns, and established programs. Legitimate interests, just not the ones a public payer is charged with protecting. CMS exists to serve beneficiaries. Its mandate is to protect patients, not programs or professions. Where a requirement principally constrains competition, restricts access, or entrenches incumbents without corresponding patient benefit, it should be removed. Politics over patients. The solo TAVR operator is not a threat to patients. It is the means of reaching them. Hardly unarmed: percutaneous rescue, disciplined case selection, a defined transfer network. CMS came some of the way. They didn't have the courage to do the right thing and patients will pay the price. doi.org/10.1016/j.jcin.2026.… @JACCJournals @SCAI @ACCinTouch @TCTMD @CRFheart @STS_CTsurgery @MayoClinicCV @rajivxgulati @SVRaoMD @drroxmehran @AjayKirtaneMD @mmamas1973 @rwyeh @adnanalkhouli @mirvatalasnag @jaygirimd @tjsimard @PietroDiSantoMD @OmarARazek @mandeep_mayo @willsuh76 @EleidMack @ChetRihal @MayraGuerreroMD @AbdullahAlabcha @aelsab @evandrofilhobr @Mahmoud_Ismayl @lamelaspablo #TAVR #TAVI

🚨 New in @EurHeartJ Does IVUS-guided PCI actually work the same everywhere? Not according to our updated meta-analysis. 17 RCTs, 14,000+ patients (10 East Asian trials, 7 non-Asian trials) comparing IVUS-guided vs angiography-guided PCI. Headline: overall, IVUS reduced cardiac death, target-vessel MI, target-vessel revascularization, MACE and stent thrombosis. But dig into the interaction testing and the picture changes: 🔹 Cardiac death: RR 0.56 in East Asian trials vs RR 1.23 in non-Asian trials (interaction P < .001) 🔹 Same directional split for TV-MI, TVR and MACE 🔹 Stent thrombosis: reduced consistently in BOTH regions (a mechanical effect, no geographic interaction) Meta-regression ruled out follow-up duration, baseline risk and lesion complexity as explanations. The pattern that fits best: how consistently IVUS findings were translated into protocolised stent optimization, which was more rigorously enforced in the East Asian trials. Take-home: IVUS guidance works. But the size of the benefit may hinge on whether centres actually act on what the imaging shows, not just whether they use it. Full paper: doi.org/10.1093/eurheartj/eh… What's your read? Is this a protocol-adherence story, or is there something else driving the regional split? #Cardiology #IVUS #PCI #InterventionalCardiology #CardioTwitter #MetaAnalysis #EHJ #CardiacDeath #EvidenceBasedMedicine @ncurzen @drjohnm @GreggWStone @DFCapodanno @DrDamluji @ziadalinyc @DrPascalMeier @SVRaoMD @mmamas1973 @CMichaelGibson @SukhNijjer @rwyeh @Drroxmehran @ajaykirtane @billgogas @DLBHATTMD @richardbogle @twj1974 @DrPeterOKane @joelgiblett @TharushaGunawa4 @gbiondizoccai

Anatomy or Physiology for Non-Culprit PCI? AIR-STEMI suggests FFR-guided PCI is better than angio guided PCI after an MI, but not for the reasons that you may think. FFR guided PCI didn't win by identifying abnormal physiology, but by reducing the no.s of stents - and related complications. This raises some interesting questions: 👉 Can we extend these results to non-ACS populations? For e.g., in pts with an abn. stress test + lesion in locations that don't match? 👉 What about pts. going for CABG? Is FFR guided revascularization superior to angiography driven CABG? 👉 Can the use of IVI and/or DCBs improve outcomes of non-FFR guided PCI? My answers: Yes, no, and perhaps!

Presented at #ESCCongress: In patients with suspected acute coronary syndrome without myocardial infarction, routine CT coronary angiography did not result in a lower incidence of myocardial infarction or death from a cardiac cause than standard care. Full TARGET-CTCA trial results: nej.md/4wH7Yk7 @escardio

Presented at #ESCCongress: In patients with severe aortic stenosis and coronary artery disease, a strategy of transcatheter aortic-valve implantation before percutaneous coronary intervention was noninferior to PCI before TAVI for major clinical events at 1 year. Full TAVI PCI trial results: nej.md/3SlY3SF @escardio

Original Article: Complete Revascularization Guided by Functional Coronary Angiography in STEMI (AIR-STEMI trial) nej.md/456gAFu #ESCCongress | @escardio

Presented at #ESCCongress: In pulmonary hypertension associated with left heart disease and heart failure, pulmonary-artery denervation reduced clinical worsening and recurrent heart failure events as compared with guideline-directed medical therapy alone. Full PADN-HF-PH trial results: nej.md/4wCHY9u @escardio

WOW! Sham #AFib ablation RCT…. neutral

In the RAPID-POP RCT (n=607 #STEMI patients), pressure-optimized stent inflation improved reperfusion vs conventional inflation-deflation (WIN ratio 1.42; P=0.004), with less post-dilation & a trend toward lower 30-day #MACE (2.0% vs 4.1%). jacc.org/doi/10.1016/j.jcin.… #JACCINT #PCI

What if a single #ECG could flag structural heart disease? #AI-ECG shows real promise, but performance changed when it left the hospital: AUC 0.83 in hospital cohorts vs 0.71 in the community. Context matters. jacc.org/doi/10.1016/j.jacc.… #JACC @djc795 @timpotsMD

Mohamad Alkhouli, MD, MBA, is the new editor-in-chief of #JACCINT. “It is a profound honor to lead the next chapter of JACC: Cardiovascular Interventions, a journal that has helped shape interventional cardiology for nearly two decades,” said Dr. @adnanalkhouli. Learn more: bit.ly/4wYBbHr

We’re pleased to announce Dr. Mohamad Alkhouli (@adnanalkhouli) as the next editor-in-chief of #JACCINT. He brings global expertise in interventional cardiology, CV research, and 10+ years of editorial leadership. 👏👏👏 Learn more about him here: bit.ly/4gItbFi

Vitals alone miss occult shock. Pressure-adjusted heart rate (RAP/MAP x HR), a novel index utilizing noninvasive RAP from TTE, predicts in-hospital & 1-yr mortality, outperforming isolated MAP, HR, & the Modified Shock Index jacc.org/doi/10.1016/j.jacad… #JACCAdvances #EchoFirst #CICU

🔥Hot off the press 📖 Pleased to share our latest paper in JCSAI on outcomes of concurrent mAFP-supported CHIP and TAVR among patients with complex CAD and severe AS. Grateful for the support from mentors @mandeep_mayo @benhibbertMDPhD @BrendenIngraham jscai.org/article/S2772-9303…

🧵 New @JACCJournals study from #CHIP-BCIS3 provides an important physiologic look at #Impella-supported high-risk #PCI—and challenges how we think about “protected PCI.” The key message: hemodynamic support ≠ myocardial protection. 1/6

In PICCOLETO X study, in pts undergoing CTO #PCI, a DCB-based strategy, either alone or in combination with stents, had favorable 1yr clinical outcomes. No significant differences between DCB-only & blended treatment with a stent jacc.org/doi/10.1016/j.jcin.… #JACCINT @Bhcintervention