The Murmur Pod

Iliac CTOs are among the highest-risk, highest-reward procedures in peripheral intervention. In this MurmurMD session, Dr. Jay Mohan joins Dr. Sameh Sayfo to break down their full approach — from diagnosis and CTA planning to crossing strategies, re-entry methods, IVUS, vessel prep, and stent selection. This case-driven conversation is packed with pearls on how to handle complex iliac occlusions s...

Not all cardiogenic shock after acute MI is left-sided — and treating it like it is can be fatal. In this MurmurMD case discussion, Dr. Chris Brown walks through a young patient with acute MI, progressive shock, and severe right ventricular failure, highlighting how early recognition and biventricular mechanical support (Bipella physiology) stabilized the patient when inotropes and balloon support...

A successful valve program isn’t built in the cath lab alone — it’s built in the clinic, the workflow, and the team structure behind the scenes. In this MurmurMD discussion, Dr. Andrei Pop and Caitlin O'Callaghan Reen, CNP, FACC walk through how they’ve structured and scaled a high-functioning valve clinic, covering everything from referrals and imaging to staffing models and follow-up. The co...

In this MurmurMD discussion, Dr. Raghava Gollapudi and Dr. Arvin Narula break down how the Watchman TruSteer sheath changes left atrial appendage occlusion (LAAO) workflows — from transeptal access to final device deployment. The conversation focuses on real-world use, and highlights when TruSteer adds value, how it improves coaxiality, and why many operators are moving toward using it routinely....

Redo groins, radiation injury, prior infection, and failed bypasses make common femoral artery disease some of the most difficult decisions in vascular care. In this case-based discussion, Dr. Nick Mouawad and Dr. Sameh Sayfo walk through two challenging common femoral artery cases where traditional open surgery carried high risk. Topics covered include: • Managing CFA bifurcation disease after pr...

Leaflet modification has rapidly evolved from niche innovation to a cornerstone of lifetime TAVR management . In this discussion, Dr. Toby Rogers joins Dr. Andrei Pop to explore the latest data, device advances, and clinical decision-making behind Basilica, Shortcut, and emerging techniques like Telltale, Unicorn, and leaflet excision . Key topics covered: History of leaflet modification — from LA...

LIMA interventions are rare, high-risk, and technically unforgiving. In this MurmurMD case session, Dr. Arvin Narula and Dr. Joe Walsh walk through an extremely challenging LIMA-to-LAD lesion involving heavy calcification, tortuosity, failed prior PCI, device entrapment, rotational atherectomy, Shockwave IVL, and management of unexpected graft thrombus. This discussion delivers real-world strategy...

Complex mitral valve anatomy continues to challenge even the most experienced TEER operators. In this month's SWAC conference, Dr. Sergio Garcia, Dr. Tom Waggoner, Dr. Mark Bieniarz, and Dr. Aidan Raney walk through how to approach PASCAL therapy in anatomies where leaflet length, clefts, stenosis, and calcification make decision-making difficult. Using multiple real patient examples, they bre...

The common femoral artery has always been considered a surgical zone—but with today’s endovascular technology, should that dogma be challenged? In this MurmurMD session, vascular surgeon Dr. Nick Mouawad joins Dr. Sameh Sayfo for a deep dive into how modern tools (IVUS, intravascular lithotripsy, advanced classification systems, and hybrid-OR workflow) are reshaping the way we evaluate and treat c...

ADR (Antegrade Dissection and Re-Entry) has historically been viewed as unpredictable — but with a structured, IVUS-sighted approach, it becomes one of the most consistent and controllable CTO PCI techniques. In this detailed case walkthrough, Dr. Robert Riley demonstrates how he performs an IVUS-Sighted ADR workflow during a complex RCA CTO. He explains how to select landing zones, create a contr...

TAVR isn’t just a procedure anymore — it’s a lifetime management decision . In this in-depth case discussion, Dr. Matt Summers and Dr. Aiden Raney dive into how hemodynamics, modeling tools, and device design are reshaping how operators approach valve selection, coronary access, and reintervention planning . Key insights include: Real-world cases showing how valve selection has evolved since 2018...

TAVR has come a long way—from a high-risk bailout procedure to a precision-driven, patient-specific therapy. In this MurmurMD case discussion, Dr. Matt Summers (Sentara Heart Valve Center) joins Dr. Aiden Raney to explore how new data, AI modeling , and simulation tools like DASI are transforming how interventionalists choose between self-expanding and balloon-expandable valves. A real look into c...

Physicians Building Devices: Powering the Next Wave of Cardiovascular Innovation Not in boardrooms—but in cath labs , by operators sharing cases, data, and ideas in real time. In this episode, Dr. David Daniels and Dr. Joe Walsh dive into how platforms like MurmurMD are connecting physicians, engineers, and startups to accelerate device innovation from the front lines of interventional cardiology....

Can creating a shunt between the left atrium and the coronary sinus improve symptoms for patients with heart failure with preserved ejection fraction (HFpEF)? In this in-depth discussion, Dr. Andrei Pop and Dr. Firas Zahr, PI of the ALT-FLOW II Trial, explore the science, physiology, and patient selection behind one of the most intriguing new frontiers in interventional heart failure. Key takeaway...

How do surgeons decide when to place an Impella 5.5 before valve surgery? In this discussion, Dr. Roland Hernandez walks through his operative approach with Dr. Chris Brown, covering: Patient selection: when balloon pump isn’t enough support Step-by-step technique for direct aortic Impella 5.5 insertion How to tunnel and remove the graft safely Technical pearls for cross-clamp position and avoidin...

What really drives gradients after TAVR-in-TAVR —and do they actually matter? In this conversation, Dr. Amr Abbas and Dr. Andrei Pop break down the nuances behind gradient measurements, patient-prosthesis mismatch (PPM), and valve expansion strategy in redo TAVR. Key takeaways include: Why echo gradients differ from invasive gradients even under identical hemodynamics Understanding discordance bet...

How often do patients leave the cath lab with residual ischemia—and can physiologic guidance change outcomes? In this discussion, Dr. Chris Brown and Dr. Christian McNeely review insights from the DEFINE GPS Trial, where PCI guided by pressure wire co-registration was compared with angiography alone. Key highlights: - Why 20% of patients left the lab with residual ischemia in DEFINE PCI - How FFR/...

How is left atrial appendage closure (LAAC) evolving in 2025—and what’s the role of 3D ICE vs TEE ? In this SWAC session, Dr. Matthew Price and panelists share their real-world experiences and expert pearls: Why 3D ICE is becoming the standard for Watchman and Amulet procedures Key tips to avoid air embolism and manage sedation risks How to safely perform ICE-guided transseptal puncture and LAA im...

Can you safely perform left atrial appendage occlusion (LAAO) without TEE, anesthesia, or an echo doc? In this episode, Dr. Raghava Gollapudi (San Diego Cardiac Center) and colleagues break down how they built a conscious sedation, ICE-only LAAO program in private practice. They cover: - Why traditional TEE + anesthesia models slow scheduling and add variability - Evidence from Europe showing ICE-...

A look into how Dr. Waggoner took a new TAVR program and transformed it into a top-tier research hub from scratch! Dr. Tom Wagner, Director of Structural Heart at Tucson Medical Center, shares his journey in building a research-first culture from scratch. In this conversation, he discusses: Why research is a differentiator in regional cardiology How he grew from zero research to 70+ active clinica...

Once considered niche, the Ross procedure is making a strong comeback. With improved techniques and long-term outcomes, it’s becoming a first-line option for younger patients with aortic valve disease. In this episode, Dr. Chris Malaisrie (Northwestern Memorial, Chicago) joins Dr. Andrei Pop to discuss: Why the Ross procedure is resurging in high-volume centers Techniques to stabilize the autograf...

TAVR explants were once considered high-risk, last-resort surgeries—with mortality rates as high as 18–20%. But recent data and surgical advances are changing the conversation. In this episode, Dr. Tsuyoshi Kaneko, Director of Cardiothoracic Surgery at Washington University in St. Louis, joins Dr. Andrei Pop to discuss:Why TAVR explant rates are rising and who needs themHow mortality has dropped t...

PCI in Complex CAD: Imaging, Physiology & Patient-Centered Decision Making with Dr. Philippe Genereux, Dr. Joe Walsh, and Dr. Aidan Raney What role should imaging and physiology play when tackling complex CAD ? In this condensed discussion, Dr. Philippe Genereux (Morristown Medical Center) shares his approach to optimizing PCI and balancing data, experience, and patient outcomes . Key takeaway...

Can you build a complex PCI and cardiogenic shock program in a community hospital without surgical backup? Dr. Mahesh Ananta shares his journey from type A/B PCI to performing Impella-, ECMO-, and CTO-supported interventions in a small hospital setting. Learn how he:Scaled a high-risk PCI program with minimal resourcesImplemented Impella and ECMO safely without in-house CT surgeryJoined a cardioge...

Short-in-tall TAVR (Sapien-in-Evolut) presents unique challenges in valve sizing, anchoring, and long-term durability. In this in-depth discussion, Dr. Andrei Pop and Dr. Gilbert Tang (Mount Sinai, Structural Heart Program Director) break down their real-world approach to: Accurate CT-based sizing for valve-in-valve procedures Oversizing and volume strategies for AR vs AS Anchoring techniques to p...