Mild PVL after #TAVR is NO LONGER acceptable, especially in low/intermediate risk and younger patients. In #JACCINT @JACCJournals the OCEAN-TAVI registry showed long-term higher mortality and TAV failure even with mild PVL. Minimizing PVL when safe should be routine now. 2 seminar studies including one from our @MountSinaiHeart @MountSinaiNYC @IcahnMountSinai by @ParasuramMD et al shows underexpanded balloon-expandable #TAVR risks early failure and ROUTINE DOUBLE-TAP post dilatation improves balloon-expandable TAV expansion! Like #PCI where you routinely pre-dilate a lesion and post dilate the stent to avoid ISR, and pre- and post-dilating in redo-PCI for ISR, optimizing valve frame expansion, minimizing PVL during index #TAVR is now paramount to confer durability, REGARDLESS of the type of TAV: balloon-expandable and self-expanding. Best view to do post-dilatation is at RAO CAU with TAV parallax removed to visualize the SHORT AXIS of the native annulus to evaluate frame geometry. WE MUST ACT NOW! OCEAN-TAVI registry on mild PVL and TAVR long-term outcomes jacc.org/doi/full/10.1016/j.… Editorial jacc.org/doi/full/10.1016/j.… Routine Double-Tap in SAPIEN 3 Ultra Resilia jacc.org/doi/10.1016/j.jcin.… Real-time Fluoroscopic analysis of underexpansion in balloon-expandable TAVR jacc.org/doi/full/10.1016/j.… Editorial jacc.org/doi/full/10.1016/j.…