The Murmur Pod

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 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 of a structural heart team, this conversation is packed with practical pearls for lifetime management of aortic valve disease.🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvAChapters:00:00 – Intro & why TAVR explant matters 01:20 – Early mortality data & fears in the field 03:50 – Why outcomes are improving 05:35 – Patient selection & referral timing 08:00 – Updated STS risk calculator for TAVR explant 10:25 – Centers of expertise & complex root work 13:15 – Techniques for small root management 15:45 – Explant after valve-in-valve TAVR 18:00 – Balloon vs. self-expanding valve challenges 20:20 – Snorkel stents and surgical headaches 22:00 – Implant strategy anticipating lifetime management 24:15 – TAVR first? The bicuspid debate 27:00 – Lifetime management beyond the first procedure 28:35 – Final thoughts on team approach#TAVR #CardiothoracicSurgery #AorticValve #ValveInValve #HeartTeam #StructuralHeart #TAVRExplant #AorticRoot #InterventionalCardiology #MurmurMD

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 takeaways include:

• When to rely on FFR vs IVUS/OCT in PCI decision-making

• Case selection pearls in left main and bifurcation disease

• Insights on DK crush, provisional stenting, and simplicity vs complexity

• Why lifetime management matters more than short-term results

• How patient values and comorbidities shape the best strategy

• Thoughts on consensus vs operator judgment in modern PCI

If you’re a cardiologist working with complex coronary disease, this session delivers concise, practical wisdom from one of the field’s most respected interventionalists.

Chapters:

00:00 – Welcome & topic overview

00:50 – Imaging vs physiology: where to start

03:00 – FFR insights in complex PCI

05:15 – Role of IVUS/OCT in left main & bifurcation disease

08:00 – Stenting strategies: DK crush vs provisional

10:30 – Balancing simplicity, complexity, and long-term planning

13:15 – Patient-centered decision making & comorbidities

15:00 – Consensus guidelines vs operator judgment

16:30 – Key takeaways & closing remarks

#PCI #InterventionalCardiology #IVUS #OCT #FFR

#ComplexPCI #Bifurcation #LeftMain #CoronaryArteryDisease #MurmurMD #Cardiology #Medical #Education

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 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 for program growth, safety, and sustainability.🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvAChapters:00:00 – Intro: Building a program without surgical backup 01:00 – Starting with type A/B PCI and early limitations 02:00 – Adding atherectomy, Impella, and ECMO safely 03:30 – Joining the Arkansas Cardiogenic Shock Initiative 05:00 – Convincing admin: outcomes + financial conversations 07:30 – First mechanical support cases and stepwise strategy 09:30 – Maintaining skills while minimizing early complications 12:00 – Training cath lab staff and changing local culture 14:40 – Leveraging industry support for devices and education 18:00 – Building trust with ICU and small-community dynamics 20:45 – Lessons for physicians building new programs #HighRiskPCI #Impella #ECMO #CardiogenicShock #InterventionalCardiology #CathLabCulture #CTOIntervention #HospitalLeadership #MCS #MurmurMD

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 prevent delayed migration

• Node 4, 5, and 6 implantation strategies and leaflet overhang concerns

• Pre- and post-dilation pearls for safety and durability

• Lifetime management, surgical considerations, and simulation insights

If you perform valve-in-valve TAVR, this episode delivers practical pearls for safer and more durable outcomes.

🔔 Subscribe for more advanced TAVR and structural heart discussions.

Timestamps:

00:00 – Welcome & Intro to Short-in-Tall TAVR

01:15 – Why Sapien-in-Evolut is Challenging

02:13 – CT Sizing & Oversizing for AR vs AS

06:30 – Anchoring, Gaps, and Delayed Migration Risk

09:00 – Node 4, 5, 6 Implant Strategies & Leaflet Overhang

14:45 – Predilation & Managing Hemodynamics

18:04 – Post-Dilation & Frame-to-Frame Optimization

23:15 – Bench vs In Vivo Behavior & Watermelon Seeding

30:21 – Valve Explant vs Second Valve: Lifetime Management

34:07 – Surgical Tips: Root Enlargement & Coronary Access

39:02 – DASI Simulations & Coronary Protection Pearls

40:47 – Closing Thoughts & Key Takeaways

#TAVR #ValveInValve #ShortInTall #StructuralHeart #InterventionalCardiology #Sapien #Evolut #ValveDurability #CoronaryProtection #CardiologyEducation #HeartTeam #TAVRStrategy #MurmurMD

Can 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 lab

How they trained nurses to lead safe, effective sedation

How to handle anesthesia buy-in and manage rare complications

What protocols and communication strategies made it all possible

Cost savings and workflow improvements you can replicate

Tom also shares his entrepreneurial journey as the owner of the largest axe-throwing bar in the Southeast — and how those business lessons apply in medicine.

📌 Whether you're planning to optimize your TAVR program or just want ideas to improve efficiency, this is a must-watch.

#TAVR #StructuralHeart #CathLab #NurseLedSedation #InterventionalCardiology #MurmurMD

Do 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 the new threshold of concern

Key differences between Watchman and Amulet devices

Watchman Flex and Flex Pro: reduced leak rates and improved safety

The role of ICE vs TEE in modern workflows

Tips on device sizing, oversizing, and how to avoid DRT

When to intervene (and when to observe)

Use of TrueSteer and the shift toward minimalist procedures

If you’re a structural heart or interventional cardiologist, this is a must-watch to help guide your clinical decision-making and device selection.

Follow the MurmurMD YouTube channel for more expert content: / @murmurmd

Download the MurmurMD app here: https://apps.apple.com/app/apple-stor...

#Cardiology #LAAC #Watchman #TEE #ICE #StructuralHeart #CathLab #strokeprevention

00:00 Introduction by Dr. Elliot Groves

00:18 Dr. Michael Rinaldi Joins the Discussion

00:50 Do All Leaks Really Matter?

01:36 Stroke Risk with Small Peri-Device Leaks

02:21 Understanding Leak Size and Stroke Magnitude

03:05 Types of Device Leaks Explained

04:03 Device Differences: Watchman vs Amulet

05:23 Confounders in Stroke Risk Assessment

06:09 Should We Intervene on Small Leaks?

06:43 Why 3mm Is the New Leak Cutoff

07:07 Clinical Significance of Small Crescentic Leaks

07:40 How Watchman Flex Changed Leak Rates

08:10 Data from PROTECT, OPTION, and CHAMPION Trials

08:39 The Future of Imaging: ICE vs TEE

09:32 Minimalist Workflow and Resource Constraints

10:19 Better Imaging, Better Devices: What’s Next?

10:36 Summary: Which Leaks Matter Most?

11:13 Deployment Tips to Minimize Leaks

12:10 When to Intervene and When to Observe

13:04 Caution Against Overusing Coils and Plugs

14:04 Debating Device Oversizing Strategies

15:05 Oversizing vs Stability: Finding the Sweet Spot

16:35 Compression, DRT, and the Ice Cream Cone Effect

17:11 Where TruSteer Makes a Difference

18:02 Why Watchman Flex Works for Most Appendages

20:08 Final Thoughts on Device Selection

21:30 Closing Remarks and Community Discussion

Ready 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 actually working
➡️ Hear how others implemented it successfully
➡️ Get inspired to level up your structural heart program

🔔 Subscribe for more cardiology insights
👥 Join the conversation on MurmurMD

📲 Download the MurmurMD App:
https://apps.apple.com/app/apple-store/id1586692687?pt=123231498&ct=curtis&mt=8
▶️ Follow MurmurMD on YouTube:
https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA

#WATCHMAN #LAAC #cardiology #structuralheart #cathlab #interventionalcardiology #MurmurMD #medicalinnovation

Stopping Bleeding with Impella: Dr. Jason Wollmuth’s Sideclose Technique

Dr. 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 Channel
App Store: Download the MurmurMD app

#cardiology #Impella #Sideclose #cathlab #interventionalcardiology #MCS #hemostasis #TAVR #valve #surgery #Abiomed #cardiotips #medtech #shorts

Chapters:

00:00 Intro and Managing Oozing

02:00 The Side Closure Technique

04:00 Managing Impella-related bleeding

05:45 Managing Impella CP Bleeding

08:00 Impella Removal and Hemostasis Technique

10:25 Impella Repositioning and Potential Complications

12:35 Expanding Sideclose use and addressing potential complications

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 radiation risk and cancer in healthcare
• Why current lead aprons just aren’t enough
• The story behind Rampart: a breakthrough in radiation protection
• The future of safety in cardiology, EP, GI, and more
• What it really takes to build a medtech startup from trauma

Whether you're in medicine, innovation, or leadership—this episode is a wake-up call you can't ignore.

Chapters: 00:00:00 Intro, Prostate cancer, and genetic expression

00:03:30 Injuries and inadequate radiation protection in the cath lab

00:05:45 Lack of formal radiation safety training and consequenses

00:09:05 Overcoming challenges and expanding opportunities

00:15:10 Risks and challenges in the cath lab

00:21:15 Physician well-being and retention

00:26:45 Addressing occupational hazards and radiation protection

00:33:15 Abdominal shielding and radiation reduction techniques

00:39:30 Radiation exposure and cancer prevention

00:43:00 Intro to Rampart data and device considerations

00:52:10 Radiation safety and protective measures

01:04:30 Mitigating risks and impacts

The #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 smaller TEE probe (57% smaller diameter) to do procedures with conscious sedation

* Tom stops blood thinner at 90 days and images at 120 days to catch DRT (CHAMPION AF protocol)

* Tom discusses his outreach strategy and how he uses patient-facing symposiums on the weekend to grow volume

Like and subscribe to see more!

Follow the MurmurMD Youtube for more tips: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA

Download the MurmurMD app here: https://apps.apple.com/app/apple-store/id1586692687?pt=123231498&ct=curtis&mt=8

#cardiology #cardio #Surgery #cathlab #valve #TAVR #shorts #surgery #medical #medicalresearch #calcium #Boston #BostonScientific #Watchman #hearthealth #hearthealthawareness