Short-in-tall TAVR (Sapien-in-Evolut) presents unique challenges in valve sizing, anchoring, and long-term durability. In this in-depth discussion, Dr. Andrei Pop and Dr. Gilbert Tang (Mount Sinai, Structural Heart Program Director) break down their real-world approach to:

• Accurate CT-based sizing for valve-in-valve procedures

• Oversizing and volume strategies for AR vs AS

• Anchoring techniques to prevent delayed migration

• Node 4, 5, and 6 implantation strategies and leaflet overhang concerns

• Pre- and post-dilation pearls for safety and durability

• Lifetime management, surgical considerations, and simulation insights

If you perform valve-in-valve TAVR, this episode delivers practical pearls for safer and more durable outcomes.

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Timestamps:

00:00 – Welcome & Intro to Short-in-Tall TAVR

01:15 – Why Sapien-in-Evolut is Challenging

02:13 – CT Sizing & Oversizing for AR vs AS

06:30 – Anchoring, Gaps, and Delayed Migration Risk

09:00 – Node 4, 5, 6 Implant Strategies & Leaflet Overhang

14:45 – Predilation & Managing Hemodynamics

18:04 – Post-Dilation & Frame-to-Frame Optimization

23:15 – Bench vs In Vivo Behavior & Watermelon Seeding

30:21 – Valve Explant vs Second Valve: Lifetime Management

34:07 – Surgical Tips: Root Enlargement & Coronary Access

39:02 – DASI Simulations & Coronary Protection Pearls

40:47 – Closing Thoughts & Key Takeaways

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