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thank you so much for the invitation from the organizers Iamp;#39;ve been given the task today to talk about Cutting Edge trials and structural heart disease at the Texas Heart Institute this is a very exciting time to be a structuralist but Iamp;#39;d like to first of all acknowledge every single one in my team and our team that does this and uh to to in the pictures there is Dr Simpson Dr conero Dr casell and Dr Liao but more importantly the people that make what I call the sauce which are you know the MPS the patient Navigator is the business coordinator is a research team so it essentially really takes a village to do this kind of trial and youamp;#39;re going to see the tasks and the challenges that we have so the surgeons know very well how to treat my twin tricuspid valve disease so you see here in this slide that the surgeons can use mitral valve repair mitral valve replacement tricuspic Valve Repair tricuspic valve replacement so us as interventionalists have started with a