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 imaging
When TEE or mini-TEE probes remain the better option
Cost, staffing, and program scaling strategies for high-volume centers
Practical steps for single-operator workflows and nursing team integration
Whether you’re a structural heart imager, interventional cardiologist, or part of a valve clinic team, this discussion highlights the future of LAAC imaging and what it takes to safely scale programs as patient volumes grow.
00:00 – Welcome & panel introduction
00:18 – Why imaging is critical for LAAC in 2025
00:37 – Matthew Price: 3D ICE is the future for Watchman and Amulet
01:03 – Boston Scientific advisory on air emboli
01:50 – Why 3D ICE outperforms 2D ICE for moderate sedation
02:11 – NCDR registry data on ICE vs TEE outcomes
02:40 – Learning curve and case volume to master ICE
03:42 – Practical workflow: efficient 3D ICE case steps
05:42 – Pre-procedure CT planning and AI sizing tools (FEOPS, DASHI)
07:11 – Tips for safe transseptal puncture with ICE guidance
09:04 – Balloon dilation vs delivery sheath crossing strategies
13:14 – Using fluoro as a backup for ICE alignment
18:08 – Aligning the ICE view to the LAA axis for accurate deployment
28:12 – Preventing air embolism during sedation-only cases
31:18 – Hydration, LA pressure checks, and sheath management
35:17 – When to choose TEE: obesity, severe OSA, or complex mitral work
40:17 – Mini-TEE probes: workflow advantages under MAC
47:01 – Pre-procedural imaging vs on-table imaging debate
52:09 – High-volume GA workflows and 4-minute deployment case
53:08 – Panel takeaways: scaling LAAC imaging programs
#LAAC #Watchman #3DICE #TEE #InterventionalCardiology
#StructuralHeart #CathLab #LAAO #ModerateSedation #MurmurMD
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-only Watchman is safe
- How to transition from TEE support to ICE-only workflow
- Practical pearls for ICE catheter handling, transeptal crossing, and imaging
- Patient selection: absolute and relative contraindications
- The role of nursing staff and team buy-in
- Why 3D/4D ICE makes device visualization easier
This is a must-watch for operators and program builders looking to simplify workflows and improve access to LAAO.
⏱️ Chapters
00:00 – Intro & program overview
01:00 – Why conscious sedation for LAAO?
02:00 – Limitations of TEE + anesthesia model
02:45 – Evidence for ICE-only Watchman safety
03:30 – Becoming a solo-operator with ICE
04:45 – Transition: 20 cases with TEE + ICE
06:00 – Patient selection: contraindications & risks
08:00 – Screening tools & nursing involvement
09:00 – Step-by-step ICE technique & home views
10:30 – Transeptal crossing: tips, 3-minute rule
12:00 – Biggest barrier: ICE-only septal crossing
14:00 – Imaging the appendage: mid & low angle views
15:45 – Benefits of 3D/4D ICE vs 2D ICE
16:30 – Final pearls for solo-operator LAAO
🔔 Subscribe for more insights from interventional experts and real-world program builders.
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#LAAO #Watchman #ConsciousSedation #ICEImaging #InterventionalCardiology #StructuralHeart #CathLab #AtrialFibrillation #SoloOperator #murmurmd
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 clinical trials
The inflection point when a program takes off (around year 5)
The importance of volume, outcomes, and clean data for sponsor trust
Practical insights on staffing: from one CRC to a full research hierarchy
Why perseverance, weekends, and attention to detail are the real “secret sauce”
How research fuels both patient access to novel devices and institutional reputation
Whether you’re a structural cardiologist, program director, or part of a valve team, this discussion offers a roadmap to building research infrastructure that benefits both patients and institutions.
Chapters:
00:00 – Intro & guest background
01:10 – Starting with zero research & 50 TAVRs/year
02:00 – Why research matters for program growth
03:30 – Research as a differentiator in regional markets
04:10 – Perseverance: the real “secret sauce”
05:30 – Balancing call, STEMI, and research demands
06:20 – The 5-year inflection point of growth
07:00 – From 2 trials to 70: scaling the research portfolio
07:45 – Importance of high volume and outcomes
08:15 – Why clean data builds sponsor trust
09:30 – Don’t overreach: starting with the right trial
10:20 – Building staff: from one CRC to a full hierarchy
12:00 – Lessons learned from early trial missteps
13:00 – Closing insights on building lasting programs
#StructuralHeart #CardiologyResearch #TAVR #HighRiskPCI #InterventionalCardiology #ClinicalTrials #CathLab #ValveTeam #ResearchProgram #MurmurMD
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 autograft and prevent dilation (deep LVOT implant, Dacron grafts, wrapping with native root)
Post-op strategies including strict blood pressure control for favorable remodeling
Durability data: 85–90% freedom from reintervention at 10 years
Managing failures: surgical re-repair, TAVR options, and future dedicated devices
Patient selection: under 50, women, and those with small aortic roots
The role of root enlargement and replacement in lifetime management
Minimally invasive approaches: mini-thoracotomy vs sternotomy
TAVR-first vs surgery-first strategies in younger patients
Why the valve clinic model and shared decision-making matter in 2025
This is a must-watch for surgeons, interventional cardiologists, and valve clinic teams navigating lifetime aortic valve management.
Chapters:
00:00 – Intro & guest background
01:00 – Why the Ross procedure is resurging
02:15 – Stabilizing the autograft: surgical techniques
04:00 – Blood pressure control & early remodeling
05:20 – Jacketed Ross and long-term durability
06:30 – Failure rates and freedom from reintervention
07:15 – Options for failing autografts & future TAVR devices
10:30 – Homografts vs autografts: differences in calcification
12:00 – Ross volumes, outcomes, and national trends
13:30 – Patient selection: under 50, women, and small roots
14:15 – Root enlargement and replacement strategies
20:00 – CT planning and AI modeling for AVR
21:15 – Minimally invasive AVR: mini-thoracotomy vs sternotomy
22:15 – TAVR first vs Ross first in younger patients
23:30 – Challenges with TAVR explant vs SAVR explant
26:00 – Techniques for safe TAVR explant
27:00 – TAV-in-TAV as a lifetime strategy
28:30 – Coronary protection & unicorn procedure
31:30 – Valve clinics & shared decision-making
33:15 – The debate over single-operator TAVR
35:00 – Closing thoughts & takeaways
#RossProcedure #AorticValve #CardiacSurgery #ValveSurgery #StructuralHeart #TAVR #LifetimeManagement #ValveClinic #InterventionalCardiology #MurmurMD
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
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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:
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!
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#cardiology #cardio #Surgery #cathlab #valve #TAVR #shorts #surgery #medical #medicalresearch #calcium #Boston #BostonScientific #Watchman #hearthealth #hearthealthawareness
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. 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 #Edwards #EdwardsLifesciences #lifescience
Dr. 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
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
