The Murmur Pod

MurmurMD
  • 0.0 (0)
  • Medicine
  • Updated Weekly

The Murmur Pod is hosted by Dr. Aidan Raney III and Dr. Joe Walsh. Specializing in interventional cardiology, they explore happenings in the cardiology and medical communities, discuss interesting cases, review new technology, and more. This podcast is presented first in the MurmurMD App! Work in the cath lab? Reach out to join the private community there!

  1. TAVR Explant Is Changing: Outcomes, Risk, and the Case for TAVR-First with Dr. Pop and Dr. Fukuhara

    1d ago

    TAVR Explant Is Changing: Outcomes, Risk, and the Case for TAVR-First with Dr. Pop and Dr. Fukuhara

    TAVR explant was once viewed as a procedure to avoid almost at all costs. Early national data showed very high mortality, creating fear among both physicians and patients. In this MurmurMD discussion, Dr. Andrei Pop speaks with Dr. Shinichi Fukuhara, from the University of Michigan, about how the field has evolved, and why newer data may change the conversation around TAVR explant, redo TAVR, and lifetime management of aortic stenosis. The discussion explores why TAVR explant outcomes have improved, how patient selection has changed, what the latest STS data suggest, and why isolated TAVR explant may now be far more reasonable in carefully selected patients than many clinicians assume. KEY TOPICS • Why early TAVR explant mortality created fear • Improved outcomes in more recent STS data • Isolated TAVR explant vs more complex explant cases • Tall-frame vs short-frame explant considerations • Why high-volume centers may matter • Hidden surgical findings after valve removal • TAVR-first as a possible strategy in selected younger patients • What a “perfect” index TAVR result should include • Coronary access, commissural alignment, and tissue ingrowth • Why lifetime management requires strong heart-team decision-making 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: why TAVR explant matters 01:03 – Early STS data and why explant was feared 02:52 – Why outcomes have improved over time 03:57 – Isolated TAVR explant and recent mortality data 06:11 – New STS risk prediction for post-TAVR surgery 07:24 – Tall-frame vs short-frame explant considerations 08:44 – Can TAVR explant outcomes be democratized? 11:16 – Why center experience may matter 12:05 – Unexpected findings after TAVR explant 12:58 – Lifetime management and risk modeling 14:19 – TAVR-first as a possible strategy 15:32 – Which younger patients may fit a TAVR-first approach? 17:25 – What a “perfect” index TAVR result requires 19:04 – Heart-team decision-making 19:19 – Tissue ingrowth, coronary access, and future risk 21:10 – What surgeons see during explant #TAVR #TAVRExplant #StructuralHeart #AorticStenosis #RedoTAVR #LifetimeManagement #HeartTeam #CardiacSurgery #InterventionalCardiology #MurmurMD

    24 min
  2. Unprotected Left Main, Low EF, and No Blood Products: How Much PCI Risk Is Acceptable?

    6d ago

    Unprotected Left Main, Low EF, and No Blood Products: How Much PCI Risk Is Acceptable?

    Some complex PCI cases are difficult because of the anatomy. Others are difficult because the margin for error is almost zero. In this MurmurMD discussion, Dr. Chris Brown and Dr. Christian McNeely walk through a high-risk NSTEMI case involving an elderly Jehovah’s Witness patient with severe multivessel coronary disease, heavily calcified distal left main disease, reduced EF, anemia, elevated filling pressures, and an occluded RCA. The central issue is not just how to treat the lesion, it is how to think through risk when both options are dangerous: surgery is preferred but not feasible, while PCI requires hemodynamic support and large-bore access in a patient who cannot receive blood products. KEY TOPICS • High-risk NSTEMI with severe multivessel disease • Unprotected calcified distal left main disease • Low EF, high EDP, anemia, and occluded RCA • Jehovah’s Witness status and refusal of blood products • Why CABG was not feasible at the time • Impella-supported PCI and large-bore access risk • Counseling when bleeding may be fatal • Limits of current complex PCI risk calculators • Shockwave IVL in the distal left main • Ostial left main recognition and stent positioning • Provisional circumflex strategy • Closure technique after large-bore access • Planning for staged RCA intervention 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Case introduction and risk stratification 00:41 – High-risk NSTEMI and severe multivessel disease 01:33 – Calcified distal left main and limited RCA options 02:20 – Jehovah’s Witness status and why CABG was not feasible 03:02 – Why hemodynamic support was needed 04:30 – Anemia, no blood products, and surgical thresholds 05:15 – Why this anatomy is truly complex 06:34 – Counseling around bleeding risk and large-bore access 08:25 – The need for better complex PCI risk calculators 10:18 – Operator risk tolerance and institutional support 11:44 – Femoral access, Impella support, and high EDP 12:16 – Shockwave IVL and loss of pulsatility 13:30 – LAD/left main stenting with circumflex preservation 14:35 – Ostial left main positioning and cusp view 15:34 – Final optimization and provisional circumflex access 16:25 – Large-bore closure with no bleeding 17:08 – Planning the staged RCA intervention 18:33 – Final thoughts on risk, consent, and complex PCI #ComplexPCI #HighRiskPCI #LeftMainPCI #Impella #MechanicalCirculatorySupport #ShockwaveIVL #CoronaryCalcium #InterventionalCardiology #CathLab #MurmurMD

    20 min
  3. Below-the-Knee IVL: Javelin, E8, and Real-World CLTI Cases with Dr. Michael Siah & Dr. Sameh Sayfo

    Jun 20

    Below-the-Knee IVL: Javelin, E8, and Real-World CLTI Cases with Dr. Michael Siah & Dr. Sameh Sayfo

    Below-the-knee CLTI is rarely straightforward especially in patients with diabetes, dialysis, medial arterial calcification, toe wounds, gangrene, and misleading ABIs. In this MurmurMD discussion, Dr. Sameh Sayfo is joined by Dr. Michael Siah, vascular surgeon at UT Southwestern, to review real-world vascular cases using intravascular lithotripsy, including Javelin and E8 strategies for tibial and pedal disease. The conversation focuses on how IVL-based therapy fits into a modern limb-salvage algorithm, especially when conventional balloons, support catheters, or crossing tools do not behave the way operators expect. KEY TOPICS • CLTI patients with gangrene, toe wounds, diabetes, ESRD, and MAC • Why ABIs can be misleading in below-the-knee disease • Using x-ray and MAC burden to anticipate difficulty • Javelin for proximal cap modification, even when it does not fully cross • E8 for tibial, plantar, and below-the-ankle calcium modification • Balloon sizing philosophy with low-pressure IVL • Avoiding embolization and perforation concerns compared with atherectomy • Pedal loop access, body floss, and long posterior tibial CTO treatment • IVL after inadequate PTA to avoid or optimize scaffolding • Wound blush, toe pressure improvement, and limb-salvage endpoints 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: vascular IVL experience and case series 00:56 – Case 1: Hallux gangrene and anterior tibial target 02:35 – Angiography, failed support catheter delivery, and Javelin 04:37 – Javelin as proximal cap modification when it does not cross 07:05 – Final result: wound blush and an E8-like outcome 07:38 – Why avoid atherectomy in discrete BTK disease? 09:26 – Case 2: Non-healing toe amputation and high MAC burden 10:16 – Distal PT occlusion and plantar perfusion strategy 10:50 – E8 below the ankle with strong wound blush 12:28 – Why larger IVL balloons can be safe at low pressure 15:12 – Case 3: Normal ABI but low toe pressure and tibial CTOs 17:36 – Failed antegrade PT crossing and pedal loop strategy 18:32 – Javelin for long PT and plantar treatment 19:32 – Final result: flow through the pedal loop and toe pressure improvement 20:58 – Case 4: Prior failed crossing and no clear AT origin 22:32 – Retrograde pedal access and subintimal angioplasty 23:38 – E8 after inadequate PTA result 24:27 – IVL as vessel prep before deciding on scaffolding 25:30 – Closing thoughts #PeripheralIVL #IntravascularLithotripsy #CLTI #LimbSalvage #BTK #BelowTheKnee #Javelin #E8 #PeripheralIntervention #VascularSurgery #PAD #MurmurMD

    26 min
  4. Aero Deliverability, Calcium Fracture, and Real-World Cases

    Jun 17

    Aero Deliverability, Calcium Fracture, and Real-World Cases

    Coronary IVL has changed the way operators approach calcified coronary disease, but the mechanism is often underappreciated because the device is so simple to use. In this MurmurMD discussion, Dr. Chris Brown and Dr. Yousif Ahmad walks through a complex calcified coronary case and then breaks down the mechanism of action behind coronary intravascular lithotripsy. The conversation focuses on Aero: improved deliverability, rewrap, and multivessel treatment in heavily calcified anatomy. Key topics include: • Severe calcified coronary disease in a high-risk patient • Using IVL with minimal lesion preparation • Deliverability through tortuous, calcified anatomy • Re-advancing a used IVL balloon after treatment • Why rewrap performance matters • Treating multivessel calcified disease more efficiently • Practical cautions around shorter pause times • How IVL fractures calcium while limiting vessel injury • Circumferential 360-degree energy delivery • Deep calcium penetration and broader energy distribution • Why coronary IVL has become a major calcium-modification tool This is a practical discussion for operators who want to understand not just that IVL works, but why it works, and how device iteration may change day-to-day calcium strategy. 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: coronary IVL case and mechanism discussion 00:17 – High-risk calcified coronary case presentation 01:47 – Minimal lesion prep and Aero IVL deliverability 02:34 – Moving, re-advancing, and reusing the IVL balloon 04:41 – Why rewrap performance changes workflow 06:04 – Final treatment strategy and angiographic result 07:06 – When IVL may replace default atherectomy 08:33 – Aero design changes: tip, coating, balloon material, and rewrap 09:08 – Practical caution: shorter pauses and ischemic time 10:45 – How IVL changes multivessel calcium treatment 11:32 – Mechanism of action: pressure waves and calcium fracture 12:32 – Consistent energy delivery and 120 pulses 13:31 – Circumferential 360-degree energy delivery 14:06 – Deep calcium penetration and broader treatment effect 15:13 – Why IVL is simple to use but complex underneath 16:01 – Closing thoughts #CoronaryIVL #IntravascularLithotripsy #Aero #CoronaryCalcium #CalcifiedLesions #CalciumModification #ComplexCoronary #InterventionalCardiology #MurmurMD

    17 min
  5. Future of Left Atrial Appendage Closure- ARCH presentation and discussion featuring Dr. Huded

    Jun 13

    Future of Left Atrial Appendage Closure- ARCH presentation and discussion featuring Dr. Huded

    In this MurmurMD discussion, Dr. Chetan Huded reviews the major trial data shaping modern LAA closure decision-making, including PROTECT AF, PREVAIL, PRAGUE-17, CLOSURE-AF, OPTION, and CHAMPION AF. The conversation focuses on the real clinical question facing physicians today: Can LAA closure match DOAC therapy for stroke prevention while reducing long-term bleeding risk? Key topics include: • LAA closure vs DOACs for stroke prevention • PROTECT AF, PREVAIL, PRAGUE-17, OPTION, CLOSURE-AF, and CHAMPION AF • Watchman FLX safety and modern outcomes • Amulet data and peri-device leak discussion • Stroke risk vs bleeding risk over time • Device-related thrombus and leak as ongoing concerns • Shared decision-making and patient selection This discussion breaks down the nuance behind the headlines and offers a practical framework for counseling patients considering appendage closure. 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Why LAA closure trials matter 02:17 – DOACs: effective, but bleeding risk persists 04:10 – Evolution of LAA closure devices 05:10 – PROTECT AF, PREVAIL, and early Watchman data 09:09 – Watchman FLX and improved procedural safety 11:01 – Amulet IDE and next-generation data 12:56 – LAAO vs DOACs: modern trial landscape 13:41 – PRAGUE-17 and CLOSURE-AF 16:53 – OPTION and CHAMPION AF 20:03 – Why trial results may appear conflicting 21:45 – Stroke, bleeding, DRT, and leak takeaways 26:41 – Ablation, rhythm control, and combined strategies 31:19 – Q&A: who should stay on medication? 40:42 – Practical clinic takeaways 49:31 – Risk buckets for shared decision-making 54:45 – Final thoughts on patient selection #LAAO #LeftAtrialAppendageClosure #Watchman #WatchmanFLX #Amulet #DOAC #AtrialFibrillation #StrokePrevention #CHAMPIONAF #CLOSUREAF #OPTIONTrial #StructuralHeart #InterventionalCardiology #MurmurMD

    56 min
  6. The DCB Playbook: Imaging, Vessel Prep, and Complex Coronary Decisions

    Jun 9

    The DCB Playbook: Imaging, Vessel Prep, and Complex Coronary Decisions

    Drug-coated balloons are creating new options in complex coronary intervention, but only when the lesion is prepared correctly. In this MurmurMD discussion, Dr. Nyal Borges and Dr. Pratik Sandesara walk through a practical, case-based approach to contemporary DCB use, focusing on ISR, calcific neoatherosclerosis, underexpanded stents, and bifurcation disease. The conversation starts with a severe LAD ISR case involving jailed diagonal branches and an under expanded stented segment. The operators discuss how imaging guides the diagnosis, why calcific atherosclerosis often requires atherectomy, when OPN and high-pressure balloons matter, and why DCB may be preferable to adding another layer of metal. They then move into a challenging LAD/diagonal bifurcation case, where the strategy becomes a hybrid approach: DES for the main LAD and DCB for the diagonal branch. Key topics include: • A practical framework for treating ISR • Differentiating tissue ISR, stent fracture, and mechanical under expansion • Why calcific atherosclerosis is so difficult to treat • Rotational atherectomy inside a stent • OPN and high-pressure balloon optimization • Imaging-guided vessel preparation before DCB • When to avoid adding another stent layer • DCB for jailed side branches and bifurcations • Cutting balloon strategy for de novo vessel prep • Using physiology to assess side branch stability after DCB • Why DES and DCB may be complementary rather than competitive This is a detailed, operator-level conversation on where DCB fits today — and why the success of DCB depends less on the balloon itself and more on diagnosis, imaging, and meticulous vessel preparation. 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: DCB in contemporary complex PCI 00:51 – Case 1: Severe LAD ISR with jailed diagonal branches 01:48 – A practical framework for image-guided ISR treatment 02:25 – Calcific neoatherosclerosis vs neointimal hyperplasia 03:20 – Mechanical underexpansion and calcium behind the stent 04:20 – Why imaging matters before choosing a DCB strategy 06:00 – DCB after vessel prep: when another stent layer is avoidable 08:00 – Why this ISR lesion is high risk for recoil 10:17 – Why OPN or IVL may not be enough in dense ISR calcium 11:35 – Rotational atherectomy inside a stent 15:09 – Long NC balloons, OPN, and confirming expansion 16:26 – Wire strategy and practical OPN considerations 18:00 – Post-treatment imaging and deciding whether to use DCB 20:04 – Why DCB may be attractive in LAD ISR with jailed branches 21:30 – What if you need to extend the stent? 25:24 – Case 2: Complex LAD/diagonal bifurcation disease 30:07 – IVUS assessment of LAD/diagonal anatomy 31:09 – Hybrid strategy: LAD stent plus diagonal DCB 31:46 – Cutting balloon and vessel prep for de novo DCB 36:10 – Using pressure wire to assess side branch stability 40:05 – When DES still makes sense in high-jeopardy anatomy 42:00 – DCB timing in bifurcation workflows 45:06 – Should you evaluate the side branch after provisional stenting? 46:02 – Final angiogram and optimization 47:10 – Future role of hybrid DES + DCB strategies #DCB #ComplexPCI #DrugCoatedBalloon #ISR #InStentRestenosis #CoronaryCalcium #BifurcationPCI #IVUS #RotationalAtherectomy #InterventionalCardiology #MurmurMD

    48 min
  7. Aero IVL: The Device Upgrade Changing Coronary Calcium Modification- Case Reviews

    Jun 3

    Aero IVL: The Device Upgrade Changing Coronary Calcium Modification- Case Reviews

    For years, the biggest limitation of coronary IVL wasn’t its ability to modify calcium- it was deliverability. In this MurmurMD discussion, Dr. Yousif Ahmad and Dr. Chris Brown review early real-world experience with Aero, ⁨@ShockwaveMedical⁩ IVL platform designed to improve crossability, flexibility, rewrap, and treatment efficiency in calcified coronary anatomy. The discussion focuses on how Aero changes day-to-day decision-making around calcium modification, including: • Why deliverability has historically limited IVL use • How Aero’s tapered tip, redesigned shaft, flexible balloon material, and longer hydrophilic coating improve performance • Why 120 pulses matter for longer calcified segments • Delivering Aero through tortuous LAD/diagonal anatomy • Using Aero in heavily calcified distal left main bifurcation anatomy • When atherectomy is still needed before IVL • Why rewrap performance may be one of Aero’s biggest advantages • Treating multiple vessels with the same IVL balloon • Reduced need for guide extension, repeat balloons, and device exchanges • How Aero may shift IVL earlier in the calcium-modification algorithm This is a practical device-focused discussion on how a seemingly incremental design change may meaningfully change how operators approach complex coronary calcium. 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Why Aero matters: IVL’s deliverability limitation 01:00 – What changed: tip, shaft, coating, and balloon design 02:00 – Tortuous LAD/diagonal anatomy and Aero deliverability 04:00 – When Aero may reduce the need for atherectomy 04:30 – Distal left main bifurcation calcium: atherectomy plus Aero 06:30 – Rewrap performance and multivessel treatment 08:00 – Fewer guide extensions, fewer exchanges, fewer ruptures 09:30 – How Aero may change the coronary calcium algorithm 11:00 – Final thoughts: why this upgrade surprised operators #Aero #IVL #IntravascularLithotripsy #CoronaryCalcium #CalcifiedLesions #LeftMain #Atherectomy #InterventionalCardiology #MurmurMD

    12 min
  8. How Transcatheter Arterialization of Deep Veins Saves Limbs with Dr. Vargas Estrada

    May 28

    How Transcatheter Arterialization of Deep Veins Saves Limbs with Dr. Vargas Estrada

    What happens when a patient has critical limb-threatening ischemia, severe calcification, no distal targets, and has failed traditional endovascular therapy? In this MurmurMD discussion, Dr. Andres Vargas Estrada and Dr. Sameh Sayfo explain the evolution of Deep Vein Arterialization (DVA/TADV) and why it has become a powerful option for patients previously considered "no-option" candidates. The conversation explores the changing landscape of peripheral artery disease, the rise of small artery disease and medial arterial calcification, and why conventional therapies often fail in advanced CLTI patients. Key topics include: • Why today's CLTI patients are different than those of the past • The impact of diabetes, dialysis, and severe calcification • Understanding the MAC score and predicting treatment failure • Why traditional tibial interventions often fall short • The role of vessel preparation before advanced therapies • How Javelin, IVL, and bioresorbable scaffolds fit into modern limb salvage • The history and evolution of Deep Vein Arterialization • How DVA reroutes blood flow to preserve limbs when no arterial options remain This discussion highlights one of the most innovative shifts in peripheral intervention: when arteries can't be reopened, use the veins. 🔔 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/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Why CLTI remains one of the biggest challenges in vascular care 03:00 – The shift from large artery disease to small artery disease 05:00 – Using the MAC score to identify no-option patients 07:00 – Modern tools: Javelin, IVL, and bioresorbable scaffolds 10:00 – The origins and evolution of Deep Vein Arterialization 13:00 – How DVA works and why it can salvage limbs 18:00 – Patient selection and practical considerations 22:00 – Future directions in limb salvage #DeepVeinArterialization #DVA #CLTI #LimbSalvage #PeripheralArteryDisease #Endovascular #PeripheralIntervention #CriticalLimbIschemia #MurmurMD

    57 min
See All (56)

About

The Murmur Pod is hosted by Dr. Aidan Raney III and Dr. Joe Walsh. Specializing in interventional cardiology, they explore happenings in the cardiology and medical communities, discuss interesting cases, review new technology, and more. This podcast is presented first in the MurmurMD App! Work in the cath lab? Reach out to join the private community there!

Information

  • Creator
    MurmurMD
  • Years Active
    2025 - 2026
  • Episodes
    56
  • Rating
    Clean
  • Copyright
    © MurmurMD
  • Show Website
    The Murmur Pod

You Might Also Like