Shows
The Murmur PodHow to Build a High-Functioning Valve Clinic: Structure, Workflow, and Real-World LessonsA 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 conversation breaks down what actually works in day-to-day practice, including:• Why valve clinics must be process-driven, not physician-dependent• How referral...
2026-01-3043 min
The Murmur PodWatchman TruSteer deep dive & Cases Steering, Coaxiality, and Deployment Efficiency in LAACIn 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.Topics covered in this transcript-based discussion include:• Why earlier Watchman sheaths limited depth and stability• How TruSteer allows four-directional control (superior, inferior, anterior, posterior)• Using the devi...
2026-01-1421 min
The Murmur PodCommon Femoral Disease Without Surgery? Two High-Risk Cases and Modern Endovascular Strategy with Dr. Sayfo and Dr. MouawadRedo 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 prior radiation and surgical complications• Why the profunda femoris artery must always be protected• Radial-to-peripheral access to avoid hostile groins• Intravascular imaging to guide vessel s...
2025-12-3016 min
The Murmur PodLeaflet Modification: Basilica, Shortcut, and the Future of Coronary Protection with Dr. Toby Rogers and Dr. Andrei PopLeaflet 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 LAMPOON to BASILICA and now device-guided proceduresHow Shortcut and Telltale are changing training and accessWhy leaflet modification is still primarily for TAV-in-SAV but expanding to redo-TAVRBalancing risk, complexity, and in...
2025-12-1933 min
The Murmur PodFixing a Calcified LIMA: Rota, Shockwave, and DCB in a Tortuous Distal LAD with Dr. Arvin Narula and Dr. Joe WalshLIMA 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, troubleshooting, and device thinking you won’t find in textbooks.Key insights from the case:• Why left distal transradial can provide safer LIMA engagement• The moment a Corsair microcatheter is “chewed up” — an...
2025-12-1017 min
The Murmur PodMastering PASCAL in Complex Mitral Anatomy: Strategy, Technique, and Real-World Lessons: SWAC Nov 25Complex 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 break down:• How PASCAL’s separatable clasps change strategy in short posterior leaflets• When to choose PASCAL vs Pascal Ace based on anatomy• Managing posterior leaflet restriction, clefts, and deep sca...
2025-12-041h 18
The Murmur PodCommon Femoral Artery Intervention: Surgery vs IVL – Dr. Mouawad & Dr. SayfoThe 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 common femoral artery disease.Using real-world experience and early data from investigative studies, the conversation covers:• When to intervene on common femoral disease• CT...
2025-12-0224 min
The Murmur PodCTO PCI Simplified: Dr. Robert Riley’s Step-by-Step IVUS Sighted ADR Technique with Dr. Chris BrownADR (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 controlled knuckle, prevent hematoma formation, orient the Stingray system correctly, and re-enter the true lumen with precision.Topics you’ll learn:When ADR is the correct strategy for a long CTOIdentifying a cl...
2025-11-2423 min
The Murmur PodTAVR Valve Choice, Coronary Access, and the Lifetime Valve Mindset: Case discussion with Dr. Matt Summers and Dr. Aidan RaneyTAVR 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 2018Using DASI modeling to predict sinus sequestration and coronary riskHow Shortcut has simplified bilateral leaflet modification and reduced procedure timesLessons learned from redo-TAVR failures, pannus formation, and HALT
2025-11-1827 min
The Murmur PodHow AI and Predictive Modeling Are Changing TAVR Valve Selection with Dr. Matthew Summers and Dr. Aidan RaneyTAVR 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 contemporary approaches to valve therapy decisions.Key insights covered:The evolution from procedural survival to lifetime valve strategyHow hemodynamics and durability data are reshaping valve selectionUsing predictive modeling (DASI) to...
2025-11-0430 min
Backtable CardiologyEp. 13 Percutaneous Tricuspid Interventions: Repair & Replacement Approaches with Dr. Joe Walsh and Dr. Aidan RaneyTricuspid valve repair has seen booming growth in the interventional arena in the last five years, and the trajectory is only up from here. In this episode, interventional cardiologists Dr. Joe Walsh and Dr. Aiden Raney share their wealth of insights and experiences with the latest advancements in tricuspid interventions.
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SYNPOSIS
The conversation covers recent landmark trials, relevant tricuspid physiology, and hands-on experiences in the cath lab with specialty devices like TriClip and Evoque. The interventionalists discuss patient selection, including how to distinguish which patients are most likely to...
2025-11-041h 02
The Murmur PodFrom Idea to Market: How to build a medical device company for physicians featuring Dr. David Daniels and Dr. Joe WalshPhysicians Building Devices: Powering the Next Wave of Cardiovascular InnovationNot 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.Key themes and insights:Why innovation starts with operators identifying real problems in the labHow peer-to-peer case sharing is shortening the feedback loop between users and builders...
2025-10-271h 01
The Murmur PodALT-FLOW II Trial: Shunting Innovation for HFpEF and Beyond with Dr. Firas Zahr and Dr. Andrei PopCan 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 takeaways:What makes ALT-FLOW different from previous intra-atrial shunt devicesHow shunt location, size, and flow patterns affect...
2025-10-2425 min
The Murmur PodImpella 5.5 for AVR: Surgical Strategy, Weaning, & Patient Mobilization with Dr. Roland Hernandez and Dr. Chris BrownHow 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 supportStep-by-step technique for direct aortic Impella 5.5 insertionHow to tunnel and remove the graft safelyTechnical pearls for cross-clamp position and avoiding floodingStrategies for weaning from bypass to Impella
2025-10-1820 min
The Murmur PodTAVR-in-TAVR Gradients Explained: Flow, Expansion & Patient Outcomes with Dr. Amr Abbas and Dr. Andrei PopWhat 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 hemodynamicsUnderstanding discordance between flow and pressure in post-TAVR assessmentWhy PPM is less concerning in normal-flow patients than previously believedHow flow state—not gradient—drives outcomes after TAVR or SAVRThe role of pre...
2025-10-0932 min
The Murmur PodDEFINE GPS Trial: Physiologic PCI Guidance, Co-Registration, & Surprising Case LessonsHow 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/iFR pullback and co-registration create a physiologic roadmap for stenting- Trial design, enrollment (2,100 patients), and endpoints: MACE at 1–2 year...
2025-10-0423 min
The Murmur PodLAAC Imaging in 2025: 3D ICE vs TEE—Techniques, Safety & Workflow | SWAC Panel Sept. '25How 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 proceduresKey tips to avoid air embolism and manage sedation risksHow to safely perform ICE-guided transseptal puncture and LAA imagingWhen TEE or mini-TEE probes remain the better optionCost, staffing, and program scaling strategies for high-volume centersPrac...
2025-09-2356 min
The Murmur PodConscious Sedation LAAO with ICE: Building a Solo-Operator WATCHMAN Program with Dr. GollapudiCan 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-only Watchman is safe- How to transition from TEE support to ICE-only workflow- Practical pearls for ICE catheter handling, transeptal crossing...
2025-09-1326 min
The Murmur PodHow to Build a World-Class Research Program: Lessons from Dr. Thomas WaggonerA 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 cardiologyHow he grew from zero research to 70+ active clinical trialsThe inflection point when a program takes off (around year 5)The importance of volume, outcomes, and clean data for sponsor trust
2025-09-0839 min
The Murmur PodThe Ross Procedure: Modern Techniques, Durability, & Lifetime Valve Management with Dr. Malaisrie and Dr. PopOnce 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 centersTechniques to stabilize the autograft and prevent dilation (deep LVOT implant, Dacron grafts, wrapping with native root)Post-op strategies including strict blood pressure control for favorable remodelingDurability data: 85–90% freedom from reintervention at 10 yearsMa...
2025-08-3036 min
The Murmur PodTAVR Explant: Why Mortality Is Dropping & How Surgeons Are Changing the Game featuring Dr. Kaneko and Dr. PopTAVR 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 to 5–6% in recent seriesThe impact of standardized techniques and better patient selectionStrategies for small root management and planning for future valve-in-valveWhen to choose TAVR explant vs. TAVR-in-TAVRThe role of early referrals and multidisciplinary valve teamsWhether you’re a cardiologist, surgeon, or part...
2025-08-2329 min
The Murmur PodChanging the Paradigm of Aortic Stenosis Treatment featuring Dr. Philippe GenereauxPCI in Complex CAD: Imaging, Physiology & Patient-Centered Decision Making with Dr. Philippe Genereux, Dr. Joe Walsh, and Dr. Aidan RaneyWhat 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 takeaways include:When to rely on FFR vs IVUS/OCT in PCI decision-makingCase selection pearls in left main and bifurcation diseaseInsights on DK crush, provisional stenting, and simplicity vs...
2025-08-1643 min
The Murmur PodBuilding a High-Risk PCI & Shock Program Without Surgical Backup with Dr. Mahesh Anantha & Dr. Chris BrownCan 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 cardiogenic shock network to improve outcomesNavigated hospital culture and financial conversationsTrained staff and changed cath lab culture for long-term successIf you’re building a peripheral or coronary MCS program—or facing resource limitations—this discussion is packed with real-world pearls...
2025-08-0629 min
The Murmur PodMastering Short-in-Tall TAVR: Valve-in-Valve Sizing, Anchoring, and Lifetime Management with Dr. Gilbert TangShort-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 proceduresOversizing and volume strategies for AR vs ASAnchoring techniques to prevent delayed migrationNode 4, 5, and 6 implantation strategies and leaflet overhang concernsPre- and post-dilation pearls for safety and durabilityLifetime management, surgical considerations, and simulation insightsIf you perform valve-in-valve TAVR, this...
2025-08-0141 min
The Murmur PodNurse-Led Sedation for TAVR: How Dr. Dahle Boosted Throughput and Cut CostsCan nurse-led sedation transform your TAVR program?Dr. Thom Dahle, Director of Valvular Heart Disease at CentraCare Heart & Vascular Center, shares how his team successfully transitioned from anesthesia-led to nurse-led sedation — and the results are eye-opening. From drastically improving throughput and consistency to dramatically reducing costs, Tom explains how this minimalist approach redefined workflows, improved patient recovery, and strengthened team dynamics.Key insights:Why they moved TAVR out of the OR and into the cath labHow they trained nu...
2025-07-2536 min
The Murmur PodAll Leaks Matter? Re-Thinking Peri-Device Leak Significance in LAA Closure with Dr. Michael RinaldiDo all leaks matter in Left Atrial Appendage Closure?Dr. Michael Rinaldi, Director of Structural Heart at Sanger Heart & Vascular Institute, offers a deep dive into the evolving science of peri-device leaks during LAAC. In this insightful discussion, he explores which leaks carry stroke risk, how device technology is changing the game, and what imaging and sizing strategies are most effective.Topics covered include:Stroke risk: how much do small leaks actually increase it?Why leaks over 3mm are...
2025-07-1722 min
The Murmur PodHow to Double Your WATCHMAN Volume: 5 Proven Strategies from Two High-Growth ProgramsReady to take your LAAC program to the next level?Dr. Joe Walsh breaks down five actionable strategies that have helped dramatically grow WATCHMAN implant volumes — not in theory, but in real-world cath labs. Joined by Dr. Samuel Horr, the two discuss how their programs overcame common hurdles, scaled smartly, and drove sustained growth through simple yet strategic changes.Whether you’re building a program from scratch or optimizing an existing one, this video delivers practical, replicable insights from physicians in the field.➡️ Learn what’s a...
2025-07-1637 min
The Murmur PodThe Sideclose Technique- a full guide from creator Dr. Jason WollmuthStopping Bleeding with Impella: Dr. Jason Wollmuth’s Sideclose TechniqueDr. Jason Wollmuth introduces a groundbreaking solution to a persistent challenge in Impella support — managing bleeding. In this episode, he walks through the Sideclose technique, a simple yet effective method now gaining traction in cath labs for improved hemostasis.✅ Full step-by-step guide✅ Practical tips from real-world cases✅ Why this matters for MCS management🎧 Want more insights like this? Join the conversation with leading interventionalists on MurmurMD.📲 Subscribe for more cath lab tips:YouTube: MurmurMD ChannelApp Store: Download the Mur...
2025-07-1015 min
The Murmur PodDon't wait for cancer or a career ending injury- what you need to know!The Silent Epidemic in the Cath Lab: A Cardiologist’s Wake-Up Call What happens when saving lives starts to cost your own?Dr. Bob Foster, interventional cardiologist and co-founder of Rampart IC, opens up about the diagnosis that changed everything. What follows is a powerful and unfiltered conversation about radiation exposure, the outdated protection still used in cath labs, and the personal and professional toll it takes on frontline medical heroes.From ruptured discs to radiation-induced DNA damage, this episode dives deep into:The truth about rad...
2025-07-031h 05
The Journey to BetterDr. Joseph Walsh - Collaborative Spaces & Murmur AppIn a profession where the stakes are incredibly high, how can collaborative platforms reshape the practice of medicine? This episode also explores the creation of Murmur, a specialized social media app for interventional cardiologists, co-founded by Dr. Joseph Walsh and Dr. Aidan Raney. We discuss the unique challenges faced by interventional cardiologists transitioning from fellowship to practice and how Murmur offers real-time advice, case-sharing, and emotional support. Discover how leveraging a robust network inspired by Annie Duke's "Thinking in Bets" can democratize expertise, enhance clinical practice, and foster a collaborative environment that transcends geographical boundaries.Finally, learn...
2024-09-131h 07The Murmur PodThe Murmur Pod Featuring Dr. Tom Waggoner #1 WACTHMAN ImplanterThe #1 Watchman implanter in the world Tom Waggoner gives an overview of his experience with WATCHMAN FLX PRO as well as tips and tricks for growing your watchman program.
Highlights:
* Hemocoat technology designed to reduce DRT (70% reduction in thombus at 14 days, 50% increased endothelial coverage at 45 days)
* Trial ongoing to investigate potential single anti-platelet therapy with new device
*Reduce untreatable LAA's with 40 mm device (6% previously untreatable now treatable)
* Fluoroscopic markers at shoulders to facilitate tug test and identify device position
* Tom uses...
2024-03-1436 minThe Murmur PodThe Murmur Pod- Ep. 2 with Dr. David Daniels
From discussing the adventures of innovating technology in the cardiology space, to breaking down why valve in valve is going to be an issue, this edition of The Murmur Podcast has it all!
Special guest David Daniels, MD shares stories and insight from an extremely unique perspective in the interventional cardiology space! This is a must watch for learning about Solo Pace Inc, catching up on current innovations in cardiology, and discussing growth through mentorship.
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2024-03-041h 24
The Murmur PodThe Murmur Pod- Ep.1Dr. Aidan Raney and Dr. Joe Walsh introduce the MurmurMD podcast, talk updates about the app. They also recap TCT studies, talk about conferences, team morale, and discuss the case of the week!
Intro and team morale- 0:35- 3:40
TCT Catchup- 3:40-6:45
Partner 3 vs. Evolut LR Apples to Apples- 6:45- 17:56
Case of the Week- 17:57- 34:54
Billing- 34:55- 37
Case recap- 37:01- 38:40
Murmur Updates- 38:41- end
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2023-11-0640 min