CardioAmp Procedure (Research)

***This is a very rough draft, please inform Hannah or Sydni of any changes that need to be made to this Wiki Page. Thank you!***

EPIC Order:

For now use Coros with Left Heart Catherization with Cardiac Anesthesia (MAC). Waiting for CAR0273 CardioAmp EHR approval.

Procedure Charges:

1. CPT 33999 (Unlisted Procedure)– CardioAmp

2. CPT 3458 – Coros with LHC

3. CPT 85347 – ACT ***every 30 minutes***MUST BE ABOVE 250***

Supplies for harvesting the bone marrow:

1. Dr Kelekar will provide the bone marrow biopsy kit

2. Size 7 sterile gloves

3. Gauze

4. Heparin Flush

Supplies provided by Biocardia:

1. CardiAmp System:

1 – CardiAmp Cell Therapy Cell Separator (Lawson# 339827)

1 – 5.2 Fr Helix transendocardial delivery catheter/dual lumen 136cm (Lawson# 554562)

1 – 8Fr Morph Universal Deflectable Guide Catheter 124cm (Lawson# 285036)

2. Centrifuge

CCL supplies for bone marrow aspirations:

1. See MD Preference (Wiki) for Coronary Catheters (Femoral)

2. LHC Angio Pack

3. VSI Micorpuncture Kit

4. Acist

5. 8Fr 10cm Sheath

6. Pigtail Catheter

7. Cordis 035 Guidewire 150 and 260 (for exchange)

8. 5cc Contrast (50% Visipaque & 50% Saline)

9. Perclose

10. Sterile IV tubing for heparinized saline bag (500 cc)

Procedure:

~ Patient in ASU.

~ Appropriate written patient consents must be signed.

~ TTE prior to procedure

~ Patient in prone position for biopsy. Clinician draws 60cc bone marrow from the iliac crest. Cell processing takes @ 20 minutes.

~ After the bone marrow aspiration but prior to initiating catherization, ensure that adequate hemostasis has occurred before proceeding with anticoagulation (Heparin) for cardiac catherization.

~ Proceed with Coronary Angiogram and Ventriculogram LAO 60 degrees and RAO 30 degrees.

~ Deflecting guide catheter is connected to a rotating hemostasis valve, flushed with heparinized saline via the side arm of the valve (continuosly running). Guide catheter inserted over the wire into the left ventricle.

~ The Helix transendocardial delivery catheter is flushed and preloaded with the therapeutic and 5cc of contrast. Use luer lock syringes.

~ Once the guide is positioned in the LV, insert the Helix catheter through the hemostatic valve into the guide catheter.

~ The interventional cardiologist will position the catheters in the endocardium of the LV. Positioned confirmed.

~ Therapeutic injection is performed.

~ A final Ventriculogram, same projections as before, is highly recommended.

~ Sheath removed and hemostasis is obtained either by manual or device compression or with vascular closure device.

https://youtu.be/AzN64rhdaCw

1. Helical Infusion Catheter advanced within Morph Guide Catheter

2. Y-connector for continuous flush

3. Contrast lumen

4. Therapeutic agent lumen

5. Helical tip engaged in myocardium

6. Helical needle with contrast lumen at base of needle

7. Control knob to deflect Morph tip