Dear Friends,
TRICO 2025, the Nineteenth International TRanscatheter Intervention COurse, was held on February 22nd and 23rd this year. This time, we aimed to incorporate several changes into our format. Along with Sanjay and me, Aman was a new addition to our cath lab team. Aman, trained by us in coronary interventions and imaging, has a particular inclination toward structural heart disease interventions. He has also been trained by his mentor, Prof. Abdurashid Mussaiyev, from Astana, Kazakhstan. Our goal was to perform live demonstrations of two TAVR cases alongside multiple complex coronary intervention cases. Additionally, we had a change in our live audio-visual demonstration crew due to the unavailability of the team we had worked with for many years.
We began preparing for TRICO 2025 in September, focusing on finalizing the agenda, connecting with national and international guest faculty, and selecting challenging PCI and TAVR cases for live demonstrations. This year, our primary emphasis was on imaging, physiology, and showcasing advanced techniques and technologies for coronary calcium management, CTOs, and bifurcation lesions. We also aimed to educate the new generation of cardiologists on the intricacies of performing TAVR cases. The program included insightful didactic sessions by both international and national guest faculty, along with a highly engaging and thought-provoking panel discussion.
Dr. Shigeru Saito from Japan and Dr. Samir Pancholy from the USA confirmed their participation as Course Directors alongside Sanjay and me. Aman was designated as Co-Director, particularly for the structural heart disease segment. We meticulously structured an intense program featuring 11 hours of live demonstrations, 9 didactic lectures delivered by esteemed national and international faculty, and an in-depth panel discussion.
Among the distinguished international guest faculty who confirmed their participation were:
• Takashi Akasaka (Wakayama Medical University, Japan) – a world authority on OCT imaging
• Rajiv Gulati (Mayo Clinic, Rochester, USA)
• Malcolm Bell (Mayo Clinic, Rochester, USA)
• Tak W. Kwan (Lenox Hill Hospital, New York, USA)
• Yuldashev Nabijon (S.H.P. Clinic, Tashkent, Uzbekistan)
• Kintur Sanghvi (Virtua Healthcare, New Jersey, USA)
• Takuya Izumikawa (Izumikawa Hospital, Nagasaki, Japan)
• Akihiko Takahashi (Takahashi Hospital, Kobe, Japan)
• Abdurashid Mussaiyev (UMC NRCSC, Astana, Kazakhstan)
Unfortunately, Khaled Ziada (Cleveland Clinic, Ohio, USA), Avtandil Babunashvili (First Moscow Medical Academy, Russia), and Mirjamol Zufarov (R.S.S.P. Medical Centre, Tashkent, Uzbekistan) were unable to attend due to prior commitments.
In addition, we had a distinguished panel of 21 national guest faculty members who confirmed their participation. A total of 21 patients were selected for live demonstrations, all of whom were admitted to Apex Heart Institute on the morning of February 21st.
Personally, I visited the Nirma University Auditorium to ensure the image and sound quality for the live transmission. Due to the change in the audio-visual crew, Yash and I worked tirelessly until late at night to fine-tune the system, as it has been a cornerstone of TRICO’s success over the years.
On the evening of February 21st, I hosted a dinner for our international guests at my home, where we shared a wonderful time together.
Proceedings of TRICO 2025 – Day 1
On the morning of February 22nd, at exactly 8:45 a.m., I delivered the welcome address from Apex Heart Institute. The Nirma University Auditorium was packed to capacity, with 453 participants from India, Uzbekistan, Russia, and several other countries in attendance.
The first live case was a complex, heavily calcified LMCA bifurcation stenosis, performed by Sanjay and me. Dr. Akasaka served as the on-site commentator. This was an extremely challenging case, requiring IVL and OCT guidance. However, as soon as we engaged the 7Fr EBU guide catheter, the patient crashed on the table, developing acute pulmonary edema, hypotension, and severe hypoxia. We were deeply concerned. The panel offered several suggestions, but in the best interest of the patient, we quickly performed high-pressure balloon dilatation of the proximal LAD and calcified LMCA segment, followed by stent deployment in the LAD and LMCA. The patient improved dramatically, and we had an engaging discussion with the panel at the auditorium. We decided to stabilize the patient and review the results the next day. The final outcome was highly satisfactory.
The second live case featured a mid-LAD CTO (J-CTO Score: 3), an extremely complex case. Dr. Saito, along with Rajni and Dr. Izumikawa, performed an outstanding live demonstration. The discussion on IVUS interpretation between Dr. Saito and Dr. Akasaka was particularly intriguing, and everyone in the audience found it highly insightful.
The third case was a long-segment, heavily calcified ostial LAD stenosis, which Sanjay and I performed. We used OCT imaging to determine the optimal strategy. Dr. Akasaka engaged in an excellent discussion with us and the panel regarding the OCT findings. We demonstrated the use of IVL to fracture the calcium, followed by another OCT scan to assess the stent size and landing zones. The final result was excellent. On-site commentators Kintur and Dr. Akasaka facilitated a thought-provoking discussion.
The fourth case was a complex RCA CTO (J-CTO Score: 3), performed by Dr. Saito with Rajni. In his signature style, Dr. Saito elegantly demonstrated the retrograde CTO crossing technique. In my opinion, Dr. Shigeru Saito is the best CTO operator in the world. The final outcome was exceptional, as confirmed by IVUS imaging. The in-depth discussion on IVUS interpretation between Dr. Saito and Dr. Akasaka reached an entirely new level of complexity, impressing everyone in attendance. With this, we concluded the first live demonstration session.
Afternoon Session
The second live demonstration session began after lunch with a highly complex in-stent restenosis (ISR) in a tortuous RCA, performed by Dr. Samir Pancholy with Sanjay. Samir conducted OCT imaging, leading to a fascinating discussion on the role of OCT in understanding the pathophysiology of stent failure. Tak Kwan and Samir Pancholy had an engaging conversation on this topic, with valuable contributions from the panel at Nirma Auditorium. The procedure was executed flawlessly, and the outcome was excellent, much to the appreciation of the audience.
The next case was a complex LAD-diagonal bifurcation stenosis (Medina 1-1-1), handled by Dr. Tak Kwan with Rajni. This was an exceptionally challenging case, which Tak managed with remarkable expertise. In my opinion, he is among the best bifurcation operators in the world. A compelling discussion ensued between him, Samir, and the panel, where he demonstrated the utility of both OCT and IVUS imaging in the same case.
Live TAVR Demonstration
The third case of this session was a live TAVR demonstration performed by Aman and Sanjay, with support from Dr. Abdurashid. Abdurashid, one of the world’s most experienced structural heart interventionalists, played a crucial role in the case. This was not a routine TAVR case, as several challenges had to be addressed. Aman led an insightful discussion on the CT scan findings with Dr. Abdurashid and the panel, which included experienced TAVR operators such as Rajiv Gulati, Manik Chopra, Kintur Sanghvi, and Ajay Swamy. We are particularly grateful to Manik for his valuable insights and encouragement, which have played a significant role in Aman’s development as a structural heart disease operator. The live demonstration was executed flawlessly, and it received widespread appreciation.
Panel Discussion and Conclusion of Day 1
Following the live demonstrations, we conducted a panel discussion at Nirma Auditorium, which I moderated for 90 minutes. The panel included esteemed international guest faculty, and the discussion focused on the role of imaging in calcium management, dissection and hematoma, stent failure, and complex coronary aneurysms. The conversation was intense and engaging, with active participation from both myself and the international faculty. Dr. Ajay Swamy provided valuable insights throughout the discussion. Everyone thoroughly enjoyed the session. With this, we concluded Day 1 of TRICO 2025.
Gala Dinner
In the evening, we hosted a Gala Dinner, attended by most participants as well as representatives from the industry. This provided an excellent opportunity for attendees to interact personally with national and international faculty members. The food was exceptional, and the atmosphere was lively. After a long and successful day, we dispersed to rest and prepare for the second day of the course.
Proceedings of TRICO 2025 – Day 2
The second day of TRICO 2025 commenced on February 23rd, with all participants gathering at the auditorium promptly at 9:00 a.m. The first case of the day was a challenging TAVR procedure, performed by Aman and Sanjay, alongside Dr. Abdurashid. Dr. Rajiv Gulati served as the on-site commentator. Aman began with an insightful presentation on the intricacies of bicuspid aortic valve disease. His confidence and ability to communicate effectively with both the panel and Rajiv throughout the case were commendable. The procedure was completed swiftly and successfully, with an excellent final outcome. I am confident that we are on the path to establishing one of the most stable structural intervention programs at Apex.
The second case presented another significant challenge—a heavily calcified mid-RCA lesion. A prior attempt had been made at another center, but the operator was unable to navigate the coronary wire. Sanjay and I approached the case with some apprehension. After carefully analyzing multiple angiographic views, we identified a complex channel in an unconventional projection. I asked Sanjay to shape the wire tip in a specific manner, and with that modification, we successfully negotiated a soft-tip wire across the lesion. However, we encountered resistance as the balloon failed to advance. Despite multiple attempts, the wire repeatedly came out, requiring us to rewire several times. With great difficulty, we managed to cross the lesion with a small balloon, creating a passage for orbital atherectomy. OCT imaging revealed a dense calcific nodule.
During the atherectomy procedure, the artery occluded, and the patient became unstable. Meanwhile, the wire dislodged again. At this critical moment, Dr. Saito joined us, expressing keen interest in the unique wire tip shape that Sanjay had crafted. Together, we successfully completed orbital atherectomy and lesion dilation. Dr. Akasaka provided an expert interpretation of the OCT imaging. This case was particularly memorable for me, as it marked the first time in 20 years that Dr. Saito and I collaborated in the cath lab. The final outcome was satisfactory, confirmed by OCT imaging. The case took nearly 150 minutes to complete, and the discussions with Malcolm Bell and the panel throughout the procedure were at an advanced level.
The third and final live case of TRICO 2025 involved a complex type-C lesion on a severe curvature of an anomalous LCX originating from the RCC. Aman and I handled this case, starting with an in-depth discussion on the choice of guide catheter, guide wire, and stenting strategy. I demonstrated the two-wire technique, using an AR-2 guide catheter to first cannulate the RCA and wire it. Carefully maneuvering the guide catheter tip towards the anomalous LCX, we successfully wired the vessel. After balloon dilation, we deployed a long stent, smoothly navigating it through the acute proximal curvature of the LCX. The final result was excellent, marking the conclusion of the live case demonstrations for TRICO 2025.
Afternoon Session & Closing
Following a lunch break, we proceeded with a series of didactic lectures delivered by leading experts in the field. The session featured engaging talks by Dr. Samir Pancholy, Dr. Takashi Akasaka, Dr. Malcolm Bell, Dr. Rajiv Gulati, and Dr. Kintur Sanghvi. Additionally, our esteemed national guest faculty, including Dr. Girish Godbole, Dr. Kamal Sharma, and Dr. Bhupesh Shah, delivered exceptional lectures.
Even after 11 hours of live demonstrations, the auditorium remained full, with attendees keen to absorb knowledge from these eloquent speakers. The quality of content and delivery was outstanding, making the session both educational and enjoyable. With this, we successfully concluded TRICO 2025—a power-packed, intense, and highly meaningful two-day journey.
I extend my sincere gratitude to Dr. Saito, all our international guest faculty, and our esteemed national faculty for their invaluable contributions in making TRICO 2025 another resounding success. We look forward to welcoming you all to TRICO 2026, scheduled for February 7th and 8th, 2026.
This year, we deeply missed our Bangladeshi participants, who were unable to attend due to visa issues. We sincerely hope to have them join us again for TRICO 2026.
Tejas Patel
Course Director, TRICO 2025
