Thread by @GilbertTangMD

@ACCinTouch @AHAScience @JACCJournals @CircAHA 2020 VHD guidelines. Here's a series of tweet-synopsis. First: #TAVR and AS. Key wasn't just Figure 3 but Table 14 where it highlights specifics favoring SAVR vs TAVR. To me it's informative. @AATSHQ @STS_CTsurgery @EACTS @escardio

#2: Bicuspid AV: recommendations on management of ascending aorta and root @NimeshDesaiMD @OPreventzaMD @OuzounianMD @EricRoselliMD @AortaSurg @DrZeigler1 @AATSHQ @STS_CTsurgery @ACCinTouch @AHAScience @JACCJournals @CircAHA

#3: Primary MR: TEER (E2E repair) #MitraClip is now Class 2A in high or prohibitive pts with "favorable" anatomy. Asymptomatic but LV dysfn DMR is Class 1 for surgery if repair possible @GAilawadiMD @DrMoritzWvB @TsuyoshiKaneko1 @AATSHQ @STS_CTsurgery @ACCinTouch @AHAScience

#4: Secondary MR: TEER (E2E) #MItraClip is Class 2A if anatomy "favorable", EF 20-50%, LVESD <=70, PASP <=70 on optimal GDMT aka #COAPT criteria. @GreggWStone @GAilawadiMD @djc795 @ACCinTouch @AHAScience @JACCJournals @CircAHA @PSorajja @SachinGoelMD @PaulMahoneyMD @modine_thomas

#5: TR: No transcatheter TV repair! (bc no FDA approved device); let's see what @escardio will say. Progressive TR (stage B): surgery at time of mitral Sx and TV annulus >4cm or prior RHF (Class 2A). @GAilawadiMD @TsuyoshiKaneko1 @ACCinTouch @AHAScience @JACCJournals @CircAHA

#6: Tissue valve antithrombotic Rx. #TAVR. 3-6 mo Plavix if low risk of bleed or VKA INR 2.5 (Class 2B). POPULAR-TAVI data on SAPT vs DAPT not considered here. @djc795 @DLBHATTMD @Argenscore @mirvatalasnag @ACCinTouch @AHAScience @JACCJournals @CircAHA

#7: Prosthetic valve failure. VIV #TAVR still only indicated in high/extreme risk pts (Class 2A) @ACCinTouch @AHAScience @JACCJournals @CircAHA @djc795 @Argenscore @BGalperMD @jtsaxon @CathElectroSurg @AdamGreenbaumMD @TsuyoshiKaneko1 @igeorge1975 @DrMoritzWvB @NimeshDesaiMD

#8 (Final): #TAVR with CAD. SAVR + #CABG Class 2A if complex LM +/- multivessel CAD with SYNTAX >33. PCI before TAVR if LM or prox CAD (2A). @ACCinTouch @AHAScience @JACCJournals @CircAHA @azeemlatib @HarryDauerman @djc795 @mirvatalasnag @GreggWStone @ajaykirtane @modine_thomas

Thoughts? @m_taramasso @hahn_rt @caresans26 @PhilippLurz @vonBardelebenRS @DrMoritzWvB @PaulMahoneyMD @PSorajja @DrTomWaggoner @EleidMack @TsuyoshiKaneko1 @tomcnguyen @Hirji1987 @JessicaLuc1