Hosts Mitsuaki Sawano, MD, and Kentaro Ejiri, MD welcome Dr. Yusuke Watanabe, MD (Teikyo University) to discuss his study from the OCEAN-TAVI Registry, examining the long-term impact of mild paravalvular regurgitation (PVR) after TAVR. In over 5,000 patients with up to 9 years of follow-up, mild PVR—traditionally considered clinically acceptable—was associated with higher risks of all-cause mortality and bioprosthetic valve failure (BVF). Even modest regurgitation appeared to have cumulative effects over time, potentially contributing to volume overload, progressive valve degeneration, and adverse clinical outcomes. The episode challenges a long-held assumption in structural heart interventions: is "mild" PVR truly benign, or does it carry meaningful long-term consequences—especially as TAVR expands to younger, lower-risk populations?

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Ryohei Ono, MD, PhD (BHF Cardiovascular Research Centre, University of Glasgow / Chiba University) to discuss his JACC: Heart Failure study, "Lactate Dehydrogenase and Outcomes in Patients With HFrEF: Insights From GALACTIC-HF." The episode explores how LDH—one of the most commonly measured laboratory tests—may be a hidden gem for prognostication, reflecting systemic hypoperfusion and multiorgan stress in patients with advanced HFrEF and offering additional context beyond traditional cardiac biomarkers.

Hosts Mitsuaki Sawano, MD, and colleagues welcome Dr. Yusuke Kobari, MD, PhD (Heart Center, Copenhagen) to discuss his recent publication in JACC: Cardiovascular Interventions, "Clinical Application of Guideline-Directed Medical Therapy in TAVR Patients With Heart Failure and Reduced Ejection Fraction." Among 336 patients with LVEF ≤40%, most were eligible for quadruple HF therapy, yet only 27% received it by 3 months. Patients on more complete GDMT had lower 2-year rates of cardiovascular death or heart failure hospitalization, while those on fewer agents had higher event rates. This episode explores an essential message: TAVR is not the endpoint of care in patients with HFrEF. Even in the structural heart era, optimization of foundational HF pharmacotherapy remains a central consideration—raising important questions about how we integrate procedural success with longitudinal medical management.