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.