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You use a graphics card holder, like https://www.newegg.com/jonsbo-model-vc3/p/1DW-0090-00006?Ite...

(No affiliation, I just clicked on the first search result)

Probably similar to the 3090Ti - it comes with a little leash that connects to the card and ties off on the top of your case!

I think we're well overdue for a redesign from the current standard ATX layout. The graphics card is now the centrepiece, and almost always the only PCI-E card in use. It's time to lay it parallel to the motherboard, or at least give it more support in some way.

Great question!

There are GPU support brackets for these behemoths.

Also known as ANTI-SAG brackets.

The first PCs had huge expansion cards, and those were mounted inside the case with clips like so:

http://dunfield.classiccmp.org/s100/h/hzinside.jpg

We could bring that back.