EOC Precise HBR vs Mitral Valve Strategy App

The PRECISE-HBR score predicts major bleeding after percutaneous coronary intervention (PCI), enabling standardized risk stratification in clinical practice and trials. The PRECISE-HBR score was developed by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria and has improved performance over the PRECISE-DAPT score, the ARC-HBR criteria, and many other risk scores.

The M-TEER Strategy & Learning App is an intelligent, structured educational and procedural decision-support platform designed to help cardiologists understand, plan, execute, troubleshoot, and continuously improve transcatheter edge-to-edge mitral valve repair (M-TEER). The app bridges the gap between guidelines, imaging, anatomy, procedural strategy, device selection, real-time decision-making, and operator learning. Rather than functioning as a simple reference library, it is designed around the way a structural heart team actually approaches a patient: Understand the pathology → assess anatomy → determine feasibility → select the strategy → anticipate challenges → plan the procedure → execute systematically → assess the result → learn from the case. At its core is a comprehensive M-TEER Strategy Engine. The user enters clinical, echocardiographic, anatomical, and procedural variables, and the application generates a structured assessment of the case. It can classify the underlying mechanism of mitral regurgitation, identify important anatomical determinants of success, assess suitability for TEER, highlight potential limitations, and suggest alternative strategies when M-TEER may not be appropriate. The platform places imaging at the centre of decision-making. Users can systematically evaluate 2D TEE, 3D TEE, en-face views, X-plane imaging, commissural anatomy, leaflet length and mobility, coaptation characteristics, flail or prolapse morphology, calcification, clefts, commissural disease, mitral valve area, transmitral gradient, and the anticipated grasping zone. The objective is to translate complex echocardiographic information into a procedural mental model. A dedicated M-TEER Planning Module converts anatomy into strategy. It helps the operator determine the likely target zone, preferred imaging views, transseptal puncture considerations, device orientation, steering strategy, grasping sequence, and anticipated technical challenges. It can present the case as a structured procedural roadmap rather than isolated measurements. The app also incorporates Device Strategy and Knobology Learning. Different device platforms and generations can be studied through interactive procedural scenarios, allowing operators to understand steering, orientation, positioning, leaflet grasping, deployment, repositioning, and troubleshooting. The emphasis is not merely on knowing the device, but on understanding why a particular manoeuvre is being performed and what anatomical problem it is solving. A major component is the Complication & Troubleshooting Engine. Users can work through scenarios such as inadequate leaflet insertion, single-leaflet device attachment, suboptimal reduction of MR, high post-procedure transmitral gradient, device instability, difficult transseptal positioning, poor trajectory, challenging commissural anatomy, residual MR, or loss of grasp. The app encourages structured troubleshooting by asking: What is wrong? Why has it happened? What anatomical or procedural variable is responsible? What should be changed next? The platform is also designed as a Learning and Simulation Environment. Cases can be presented as progressive clinical simulations in which the learner makes decisions at each stage. The system can reveal consequences of those decisions, compare alternative strategies, and provide expert explanations. This creates an environment for deliberate practice before entering the catheterization laboratory. An integrated Case Library can contain normal mitral anatomy, degenerative MR, functional MR, mixed pathology, complex anatomy, failed procedures, bailout strategies, and challenging real-world cases. Each case can include clinical information, TTE, 2D/3D TEE, CT where relevant, procedural videos, questions, decision points, final strategy, outcome, and expert commentary.