"Hello, I'm Dipti Itchhaporia and I am at ACC 25 and we've had an incredible congress with some really great trials that were presented and I thought I would give you some thoughts about the meeting and maybe highlight a couple of the trials.

So the first one is sort of testing the dogma of fluid restriction. So I'm going to talk about FRESH-UP. I thought that this was a really interesting trial. I love trials that really do go against, you know, maybe potentially what we've been always doing. And we all believe that fluid restriction is the way to go. So this was a trial that looked at fluid restriction versus liberalising the fluids. So it was 1500cc's versus liberal fluid restriction in patients and to see if they did worse in terms of the heart failure. So they looked at quality of life metrics using the Kansas City Cardiomyopathy Questionnaire and, and what they found was that liberal versus fluid restriction was very similar in terms of quality of life. And actually the patients that had more liberal usage had less thirst and better quality of life. And so it goes against the dogma that we need to fluid restrict all these patients. Now, obviously there were secondary endpoints that were more clinical parameters, but they weren't powered high enough for us to really take away something. But in terms of quality of life parameters, certainly we can maybe use liberalised fluids in our patients.

The second trial that I wanted to hit on was the API CAT trial. And this was a trial that looked at low dose apixaban in cancer patients as long term VT el prophylaxis versus standard dose. So these were all patients that had cancer diagnosis and they had, they were diagnosed with a venous thromboembolism. So they either had a pulmonary embolus or a DVT. And these patients were treated for six months of apixaban. And after the six months they were randomised to either low dose 2.5 milligrammes twice a day versus the standard dose, 5 milligrammes twice a day. And they followed these patients and the patients that were on the low dose did just as well in terms of VTE, but had less bleeding. So this really will be a game changing trial and I believe this will be incorporated in the guidelines. So I think going forward we have in the United States about 2 million cancer patients. So this will be sort of a standard, I think in terms of VT prophylaxis in these cancer patients.

The next is the ALIGN-AR trial and I liked this one because right, Currently, if you have a patient with aortic regurgitation, we don't have any percutaneous therapies that have been approved. And this is a trial that looked at Jenavalve in these patients with symptomatic aortic regurgitation and they were able to safely implant the Jenavalve in these patients with really no safety concerns. So I think. And these patients had improvement in terms of their heart failure symptoms. So I think this is exciting because we don't have any therapy for AI, so I think there's more to come with this. And it was a teaser, I think, in terms of where we're going in this, in this arena.

And the last one I wanted to talk about was the PROTECT TAVI. This is a cerebral embolic protection device we're put in these patients. It did not decrease the incidence of CVA at 72 hours. Now, this is the largest randomised trial to date. We're looking at the cerebral embolic protection devices and this is with over 7,000 patients. But again, I think although the trial did not show a reduction in terms of stroke, it is hard to believe that when they collect all of that embolic material that we would not see a difference. I don't know that we understand the mechanism and maybe other generation devices may be helpful. So I think these are just a few of the trials that I think were interesting. There were certainly many more interesting trials, but for the time given, this was sort of a little bit of a flavour of what was happening at ACC 25. Thank you.”