RESHAPE HF II vs COAPT & MITRAL‑FR: Unraveling the MitraClip Debate

RESHAPE HF II vs COAPT & MITRAL‑FR: Unraveling the MitraClip Debate

Welcome to IC Chat with host Dr. Ashish Pershad. In this episode we examine the controversial role of transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation, focusing on the COAPT, MITRAL‑FR and the newer RESHAPE Heart Failure II trials. We summarize trial differences in patient selection, anatomy (EROA and LV volumes), outcomes (heart failure hospitalizations, quality of life and mortality), and methodological concerns that influence interpretation of RESHAPE HF II. Dr. Pershad outlines the practical implications for clinicians: selection remains critical, TEER appears to reduce heart failure admissions and improve quality of life in selected patients, but questions about mortality benefit and broad adoption persist.

ORBITA CTO: The Sham-Controlled Trial That Shook CTO-PCI

In this episode host Ashish Pershad reviews the ORBITA CTO randomized, double-blind, sham-controlled trial that compared CTO-PCI to a placebo procedure, explaining the rigorous design, patient selection, masking methods, and statistical approach. Pershad summarizes the results showing significant symptom improvement with CTO-PCI, discusses clinical implications—blinding, careful case selection, and specialist referral—and outlines how this trial advances evidence for procedural interventions for patients with stable angina.

The IC CHAT episode 17 —Is the MFP necessary for all HR-PCI cases? CHIP-BCIS answers this very question

Host Dr. Ashish Pershad introduces IC Chat’s mission to help clinicians interpret evidence-based medicine and translate trial data into everyday patient care. In this episode he appraises the CHIP-BCIS-3 randomized trial (ACC 2026 / NEJM) comparing prophylactic microaxial flow pump (Impella) versus standard care in very high‑risk elective PCI patients. The trial enrolled patients with low LVEF and high SYNTAX/BCIS scores and used a hierarchical win‑ratio primary endpoint. Results showed no overall benefit for Impella and a concerning signal of increased cardiovascular mortality at two years in the device group, despite similar completeness of revascularization and low bleeding/vascular complication rates. Dr. Pershad discusses implications: avoid routine prophylactic Impella in elective high‑risk PCI, consider staged revascularization, and call for reappraisal of device use and approval processes to prioritize patient safety.

CHAMPION‑AF Decoded: Watchman Flex vs DOACs

In this episode of ICChat, Dr. Ashish Pershad MD MS  reviews and critiques the CHAMPION‑AF trial comparing Watchman Flex left atrial appendage occlusion to DOACs for atrial fibrillation. He explains the trial design, endpoints, and statistical choices, and contrasts the published results with real‑world implications. The episode highlights concerns about non‑inferiority margins, excluded procedural bleeding, lower than expected event rates, and the importance of shared decision making when considering LAAO versus lifelong anticoagulation.

Long term TAVR data

Critical appraisal of the 6-year Evolut low risk trial data and a one on one with Steve Yakubov one of the senior authors on the paper for his take on TAVR adoption in low-risk patients