Will use excellent illustrations from Sarah Chen, a PGY5 I6 resident at UC Davis, and a medical illustrator for Ann thorac surg and short video clips to explain each step. Welcome discussions and question.

Look into figure 8. The PPM defined using EOA by individual echo measurement reflects dramatic difference of long term survival between no PPM and any PPM. That’s how PPM should be defined, not the EOA from valve company or predicted EOA published in literature

We have done 140+ consecutive now, including two cases of endocarditis. The results remained the same. Hemodynamics and LVH further improved in the second year. Median AVA went up to 2.4 cm2, and mean gradient remained 6-7 mmHg, better than TAVR (presented at STS 2023)

Great team work, go blue!!!!

Great job by Armi, our medical student, and the team

Grea work from Ying Yang and Dogukan Mizrak and our lab!!!! Also great support from our patients.

Great work by Jama, Laurent and Gebrine

Igor Konstantinov Edward Buratto Bo Yang Edem Binka Reilly D. Hobbs MD MBS S. Adil Husain Joseph W Turek Maximiliaan Notenboom Elizabeth Stephens, MD, PhD JosephDearaniMD Francesca Sperotto, MD PhD Nicola Maschietto Stephanie Nguyen Dr. Kanwal M Farooqi Emile BACHA Dr. Manan Desai MD Yves d'Udekem Aybala Tongut, MD. Can Yerebakan Mami. Ismail El-Hamamsy, MD, PhD

Using transcriptomics really helps micro dissect the change of gene expression of the media of the vessel due to TGFBR1 mutation.

Great work from Dr Grubb and colleague

Great to have Sarah Chen, CT resident fro UC Davis visiting us for a week as the winner of TSRA/STS Traveling Fellowship in Cardiothoracic Surgery

Congratulations to our graduating aortic fellows, Alex Brescia, Ken Hassler and Farhang Yazdchi. You all have done a great job. The world is waiting for you!! Good luck to your new jobs. You all have bright future!! Save more patients!!

annalscts.com/issue/view/651 this is the link to the issue in May in ACS, papers, presentations, videos by experts in TAVR-SAVR trials, PPM, valve size, root anatomy, SVD, techniques of annular enlargement, pitfalls and updates, illustrations of Y-incision. It’s open to everyone

Explanted 23 sapient, enlarged the annulus from 19 to 25. The opening of old TAVR valve was < 1/3 of the new SAVR valve. coronary Ostia were above the SAVR valve. Aortic annular enlargement should be routine in SAVR like LIMA in CABG, especially in redo SAVR after SAVR or TAVR.

We enlarge the crown shape annulus and root liberally. All my fellows mastered this technique. But I don’t put size 29 in every pt. Some gets 25 or 27 which matches the native annulus of 19-21mm. When the LCA ostium is low, <5 mm, downsize from the largest size by 1 valve size.

I showed this case to leaders in cardiology. Their comments are this is good results. But most surgeons in the US would put a size 19 or 21 for this pt. Not sure that is better than TAVR.

The application for aortic fellowship at Michigan will open soon

Last case with our aortic fellow, Ken Hassler. Congratulations, Ken, a bright future is waiting for you!!