Welcome to our annual issue conceptualized around sharing procedural techniques across specialties. For this issue, we enlisted expert commentary from your peers to help share tips, tricks, and techniques that may help to influence your daily practice. We begin with an overview by Antonio Mangieri, MD, and Antonio Colombo, MD, of cutting, scoring, and very-high-pressure specialty balloons and when and how to use them in percutaneous coronary intervention (PCI).

Next, Mattia Lunardi, MD, and Flavio Ribichini, MD, explore how, with proper technique and equipment, achieving coronary access through a transcatheter heart valve for coronary angiography or PCI after transcatheter aortic valve replacement (TAVR) is feasible.

Arber Kodra, MD; S. Jay Mathews, MD; and Asma Khaliq, MD, detail procedural techniques and provide advice for using the Indigo Lightning (Penumbra, Inc.) and FlowTriever (Inari Medical) systems for acute pulmonary embolism thrombectomy.

Direct pacing over the left ventricular guidewire has been proposed to streamline TAVR procedures and reduce possible complication related to conventional right ventricular pacing. Mauro Boiago, MD, and Nicolas Dumonteil, MD, review left ventricular pacing techniques in four steps, including special considerations and the materials required.

S. Jay Mathews, MD, then provides a step-by-step technical guide for coronary thrombectomy.

We close this collection of technique articles with Mahmoud Al-Naili, MBChB(LY); Jens Hitzeroth, MBChB, and Mpiko Ntsekhe, MD, who guide us through safely and successfully performing apical pericardiocentesis using continuous echocardiographic visualization.

In our Today’s Practice column, Joe Sasson, PhD, and Marc Toth, CMAA, explore whether cardiovascular ambulatory surgery centers are hitting the mark of health care’s quadruple aim.

Finally, it has been 20 years since the first-in-human TAVR procedure forever changed the landscape of our specialty. In our featured interview, Alain Cribier, MD, shares the inspiring and challenging story of TAVR’s origin and legacy; from the beginnings of an idea to the first-in-human procedure and from fighting for acceptance to influence on other valvular diseases.

We hope this issue provides you with new insights and practical information for expanding your practice and skill set.

Azeem Latib, MD
Chief Medical Editor
Manaf Assafin, MD
Guest Chief Medical Editor