Ken, that was a great discussion, and, you know, elderly patients, not only are they underrepresented in the TAVR, you know, treatment, they're also delayed. If you look at the time to touch at the valve clinic to when they actually come in and get the TAVR across the country, they're clearly delayed as well, and that's an issue as well. I'd just like, I'd just start with, and then how do you guys look at this? You know, you got a 90-year-old. Actually, so I've got a great question. If I can, like, slightly turn the question a little bit, so in our valve clinic on Wednesday, my partner saw an 89-year-old lady who is, she's almost 90, but, you know, functional 89-year-old, severe aortic stenosis, and a calcified STJ. I've never seen anything like this, so I've got the screenshot. I wish I had a slide. Protruding calcium at the STJ, like, I mean, just, like, protruding out into the aorta, so Keith is here. I don't know if there are other surgeons here. We almost never think about surgery now for an 89-year-old lady, right, but, like, Keith, what's the oldest patient that you've operated on for AS, like, in the last five years? You know, I mean, should we, you know, what should we do here? 96? Why did, why did you operate, why did we operate on her, him, her? I'm sure she had some protruding calcium, she's a calcified STJ. I mean, yeah, so the debate is, you know, you know, the debate in this case is not should we treat her. Should we definitely need to treat this lady? She's functional. She's 89, but we almost never operate on these patients anymore, and so should we, you know, and tell her what the risk is and do a TAVR, or should we operate on her? I'm sorry. We can't cut your request today, but I'm very much not ready for any more of that discussion. It's a challenge for a challenging person, for a retailer like ours. Now, because of that, we decided that we would put it on the board. This is not going to be a wall that we're going to have to fight to remove. So, very interesting, because on Wednesday, I was here, but my team just did the same patient that you were just talking about, who, and 89 as well, who's had multiple admissions for heart failure, but when he's not in the hospital, he's on his ranch, working on his ranch in Texas, has the same calcium pattern that you're talking about. We wanted to do a self-expanding valve, but his STJ, excuse me, his sinuses weren't large enough, so we had to do a balloon expandable valve, and of course, we're all like, just be soft, just be soft. Well, yesterday, I got the image of the rupture, the annular rupture, contained annular rupture, and I mean, the guy's doing fine right now, you know, but that's the, right? I mean, what do you do with these patients? You know, I think our perspective in a valve clinic is very different than many general cardiologists and primary care. They get to 90, there's nothing that should be done or can be done, and there's some education to be done out there in the community as well, because, you know, the ones we choose to do, do really well. Yeah. I think that's the bottom line. Well, I think nowadays, the cohort C patient is the hardest thing to decide, because basically what we are asking of ourselves is to look in a crystal ball and decide whether or not that it's, you know, that the outcomes are going to be great.

elderly patients

severe aortic stenosis

transcatheter aortic valve replacement

TAVR

treatment options

aortic

TAVI